Senate Hearing, 113TH Congress - The Fiscal Year 2015 Budget For Veterans' Programs

S. HRG.
113599
THE FISCAL YEAR 2015 BUDGET FOR

VETERANS PROGRAMS
HEARING
BEFORE THE
COMMITTEE ON VETERANS AFFAIRS

UNITED STATES SENATE
ONE HUNDRED THIRTEENTH CONGRESS
SECOND SESSION
MARCH 12, 2014
Printed for the use of the Committee on Veterans Affairs
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COMMITTEE ON VETERANS AFFAIRS

BERNARD SANDERS, (I) Vermont, Chairman
RICHARD BURR, North Carolina, Ranking
JOHN D. ROCKEFELLER IV, West Virginia
PATTY MURRAY, Washington
Member
SHERROD BROWN, Ohio
JOHNNY ISAKSON, Georgia
JON TESTER, Montana
MIKE JOHANNS, Nebraska
MARK BEGICH, Alaska
JERRY MORAN, Kansas
RICHARD BLUMENTHAL, Connecticut
JOHN BOOZMAN, Arkansas
MAZIE HIRONO, Hawaii
DEAN HELLER, Nevada
STEVE ROBERTSON, Staff Director
LUPE WISSEL, Republican Staff Director
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C O N T E N T S
MARCH 12, 2014
SENATORS
Page
Sanders, Hon. Bernard, Chairman, U.S. Senator from Vermont ........................

Isakson, Hon. Johnny, U.S. Senator from Georgia ...............................................
Brown, Hon. Sherrod, U.S. Senator from Ohio .....................................................
Johanns, Hon. Mike, U.S. Senator from Nebraska ...............................................
Tester, Hon. Jon, U.S. Senator from Montana ......................................................
Hirono, Hon. Mazie, U.S. Senator from Hawaii ....................................................
Murray, Hon. Patty, U.S. Senator from Washington ...........................................
Blumenthal, Hon. Richard, U.S. Senator from Connecticut ................................
Boozman, Hon. John, U.S. Senator from Arkansas ..............................................
Moran, Hon. Jerry, U.S. Senator from Kansas .....................................................
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WITNESSES
Hon. Eric K. Shinseki, Secretary, U.S. Department of Veterans Affairs; accompanied by Hon. Robert A. Petzel, M.D., Under Secretary for Health;
Hon. Allison A. Hickey, Under Secretary for Benefits; Hon. Steve L. Muro,
Under Secretary for Memorial Affairs; Stephen W. Warren, Executive in
Charge for Information and Technology; and Helen Tierney, Executive in
Charge for the Office of Management and Acting Chief Financial Officer .....
Prepared statement ..........................................................................................
Response to posthearing questions submitted by:
Hon. Bernard Sanders ..................................................................................
Hon. Richard Burr ........................................................................................
Hon. Jerry Moran .........................................................................................
Hon. John Boozman ......................................................................................
Hon. Dean Heller ..........................................................................................
Response to request arising during the hearing by:
Hon. Johnny Isakson ....................................................................................
Hon. Patty Murray ........................................................................................
Hon. Jon Tester .............................................................................................
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APPENDIX
Zumatto, Diane, National Legislative Director, AMVETS; prepared statement
Varela, Paul R., Assistant National Legislative Director, Disabled American
Veterans; prepared statement .............................................................................
Paralyzed Veterans of America (PVA); prepared statement ................................
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(III)
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THE FISCAL YEAR 2015 BUDGET FOR

VETERANS PROGRAMS
WEDNESDAY, MARCH 12, 2014
U.S. SENATE,
VETERANS AFFAIRS,
Washington, DC.
The Committee met, pursuant to notice, at 2:02 p.m., in room
418, Russell Senate Office Building, Hon. Bernard Sanders, Chairman of the Committee, presiding.
Present: Senators Sanders, Murray, Brown, Tester, Blumenthal,
Hirono, Isakson, Johanns, Moran, and Boozman.
COMMITTEE
ON
OPENING STATEMENT OF HON. BERNARD SANDERS,

CHAIRMAN, U.S. SENATOR FROM VERMONT
Chairman SANDERS. OK, lets get to work.

I want to thank all of our guests from VA for being with us today
to discuss the budget.
Let me begin by thanking General Shinseki and others for tackling some enormously difficult problems in this enormously difficult
period facing our veterans. I think if there is anything that I have
learned in the year and 3 months that I have been Chairman of
this Committee it is that the cost of war is much, much greater,
I think, than most Americans perceive.
We are dealing now with hundreds of thousands of men and
women who have come home from Iraq and Afghanistan, dealing
with traumatic brain injury and post traumatic stress disorder.
Those are tough illnesses to deal with, and the magnitude, the
numbers, are extraordinary. That is an issue I think we will focus
on todaythe magnitude of that problemhundreds of thousands
of men and women dealing with TBI and PTSD is a huge issue.
We have seen 2,300 individuals suffer wounds in war that make
it impossible for them to have kids. How do we respond to that?
We have seen a situation within the VA and throughout our
country there is a feeling that too many patients are being overmedicated. What kind of alternatives are out there?
And I think VA, by the way, is doing some cutting-edge work in
trying to respond to pain and other problems through complementary and alternative medicine. How do we address that?
We are dealing with an issue that several years ago the U.S.
Congress passed a very, very important piece of legislation, making
sure that people who served in Iraq and Afghanistan have the ability to go to college. That has worked, by and large, very, very well.
Problems remain. How do we address that?
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Going back to the issues of mental health, we are all distressed
and saddened by the number of suicides that we face, a very difficult issue inside the military, inside the VA, inside the United
States of America, our general population. How do we deal with
that?
We are dealing with the issue that the VA, in the last several
years, has transformed their claims systemgoing from paper to
digital. We think we are making some progress. We want to continue that progress. How do we make sure that we continue that
progress so that every veteran in this country gets their claim adjudicated in a timely manner?
The VA has, in my view, over the years done a good job in terms
of reaching out in primary health care through CBOCs. How do we
make sure that the proper number of CBOCs continue to be built
and maintained?
So, we have a whole lot of issues facing us. These are tough
times for the veterans community, coming out of two wars, dealing
with older veterans from World War II, Korea, Vietnam, and we
are not going to turn our backs on those veterans.
I, again, want to thank the VA. It is very easy to beat up on the
VA because they are big, they are bureaucratic, and they are public, so that every problem they have, which is many when you run
151 medical centersI am sure that there is a problem at every
one every day, and often they get on the front pages. But sometimes we forget that many millions of veterans are accessing them
and are very proud and happy with the care that they are getting.
So, our job is to keep the VA moving forward, address the serious
problems they have, give them the support they need, and that is
what this budget hearing is about.
Senator Isakson.
STATEMENT OF HON. JOHNNY ISAKSON,
U.S. SENATOR FROM GEORGIA
Senator ISAKSON. Well, thank you, Mr. Chairman.

I appreciate Secretary Shinseki, Dr. Petzel and the rest of you
for being here today. I appreciate the job that you do.
Chairman Sanders made a very obvious statement; you all are
very easy to pick on, but you probably have the hardest job in
Washington, DC, and the biggest responsibility in the years to
come. We are grateful for your service and grateful for what you
do.
As I understand it, your request calls for $10 billion in an
increase in VAs overall budget and $2 billion in discretionary
spending.
You know, our responsibilities in Washington are to appropriate
and to legislate, but we also have another responsibility in our
committees, and that is oversight.
Some issues came up this morning that I think I want to address
in my opening statement so that Secretary Shinseki can possibly
address them in his responses later in the hearing.
As we heard from the Wounded Warrior Project this morning,
one area that needs oversight is the caregiver program. What we
know about this program so far included inconsistent decisions regarding eligibility, no quality assurance to monitor the quality, con-
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sistency, and timeliness of decisions, and no formal process to appeal the decision or eligibility for caregiver assistance.
I know many, including Chairman Sanders, believe this program
should be expanded and included to all veterans. Yet, we need to
ensure its proper implementation before we expand this program.
We should do this for any program and provide the oversight necessary to do it right.
Since the beginning of 2013, the Veterans Health Administration
has been plagued by a series of quality management issues that
have resulted not only in patient harm but also patient death.
These issue range from the misuse of a single patient multi-use insulin pen to an outbreak of Legionella to delays in mental health
care and GI consults.
You all know what we have experienced in the Atlanta VA, at
the medical center in Atlanta, with regard to mental health and
suicide.
The inspector general has released over 40 health care inspections during the Congress. That is roughly three per month.
Veterans have sacrificed so much already and deserve worldclass health care, yet our Nations veterans are facing long delays
in scheduling appointments and assessing needed services.
Another area the veterans face is the longtime backlog in claims,
which I know you are making progress on. I know by 2015we
have goals that are terrific, but we have got to make sure we deal
not just with statistics but with the actual effect on the lives of
these veterans and their families.
So, this work on reducing the claim times and the waste is going
to be critically important. 1.2 million veterans still wait today for
a determination. That is a huge number; there are way too many.
On the issue of suicide, I want to thank Robert Petzel immensely
for three thingsone, his willingness to come to Atlanta in the
field hearing that we conducted in August including 2-12 hours of
emotional, and I am sure painful to a certain extent, information
about the tragedies we had in the Atlanta VA with three suicide
deaths and one drug overdose.
Mr. Secretary, I want to commend you on the replacement of the
director at the hospital. The new director, Ms. Wiggins, is doing an
outstanding job.
Unfortunately, we had another incident about 2 weeks ago. She
was on the phone to me first when it happened, took immediate action in terms of that incident, and accepted responsibility where responsibility was needed to be accepted.
That is a great indication of the emphasis you, the Secretary,
have putand Robert Petzel has puton this issue of suicide,
which we must get our arms around. It is one area where I think
oversight is going to be critical for us to move the paradigm and
get best practices in every VA medical center in the country.
Soft tissue injuries are the toughest to deal with. TBI and PTSD
are the legacy of the contemporary wars we have been fighting.
And suicide is the nasty byproduct of a drug overdose and misuse
of drugs in terms of treating people and not having the right mental health follow-up with those patients.
I am going to personally dedicate a lot of my timeI know John
Boozman on our Committee is going to do the sameto delve into
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the issues of suicide, find out where those tragedies are taking
place, and see if we can find common threads where we can implement best practices in the Veterans Administration so we do not
lose so many soldiers by taking their own lives.
Right now, we are losing an average of 22 a day, which is 8,000
a year, and that is far too many. And it is not just combat veterans
from Afghanistan and Iraq. In fact, in Atlanta, three of the four
victims were veterans of the Vietnam-era war.
It is a pervasive issue in the VA. It is actually a pervasive issue
in the United States. We owe it to our veterans and to our country
to see to it that we find every best practice possible and implement
them.
One of the things I am going to do, Mr. Chairman, is I am going
to, as a one-man band or vigilante of one, is have field hearings
or, as a Committee representative, have field hearingsand do the
oversight around the country necessary to bring the best practices
to light, to try to do what Robert Petzel is doing right now, which
is meeting with these veterans, getting the right answers, and trying to correct the paradigm, which I am grateful for you to do.
I yield back the balance of my time.
Chairman SANDERS. Thank you.
Senator Brown.
STATEMENT OF HON. SHERROD BROWN,
U.S. SENATOR FROM OHIO
Senator BROWN. Thank you, Mr. Chairman. I appreciate your

leadership.
Thank you, Mr. Secretary and all of you who are serving our veterans and serving our country so ably and so selflessly. Thank you
for that.
I reiterate the Chairmans comments about the cost of war.
I think that Senator Isaksons aptly pointing out the terrible afflictionand Senator Tester has talked to me about this, tooof
suicide in the military attests to that, as do unemployment rates,
as do mental health problems, as do drug addiction, all of those
costs of war that we should think about in this body more than we
do.
A couple of things I wanted to mentionone is VRAP and the
significant contribution the Veterans Retraining Assistance Program has made to our veterans, to our communities.
I have one brief story. Everett Chambers in Cleveland used
VRAP funds to get retrained as an electrical engineering technician
at Cuyahoga County Community College. He is one of a number of
people I have met in Youngstown, Cincinnati, and all of over my
State, who have benefited from VRAP. It is a program that works.
We should do all we can to make sure that more people have that
opportunity.
Obviously, you cannot come in front of us without discussing the
disability claims backlog and disability ratingsthe unevenness of
the ratings from a bum knee in San Diego being rating differently
in terms of dollars than a bum knee in Columbus or Cleveland. The
fixing of both the backlog and the disability ratings together makes
sense.
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The last issue I would like to mention is I remain concerned with
the Departments outsourcing more and more work. First, I believe
the quality of outsourced work is often subpar. Second, many contractors lack the dedication of career civil servants, especially when
you realize that places like the VA in Chillicothe, how assiduous
they have been about hiring veterans, and I know that VA centers
and CBOCs all over the country strive for that.
We should not be outsourcing these jobs. Civil servants who decide to pursue a career assisting veterans lead to better services
compared to services provided by those that are motivated by profit. I think we have seen that in example after example after
example.
It does not save taxpayer dollars. It may help politicians, but it
does not save taxpayer dollars. We saw this at the very basic level
in places like the Dayton VA medical center where laundry was
outsourced and now workers say the clothes come back not as clean
as they were.
If the VA continues to outsource more and more activities, at
some point, we are going to reach a point where the VA is a health
insurance provider and not a health care provider. That does not
serve veterans. It does not serve taxpayers. It does not serve the
public.
So, again, I thank you for your service, all of you.
Chairman SANDERS. Thank you, Senator Brown.
Senator Johanns.
STATEMENT OF HON. MIKE JOHANNS,
U.S. SENATOR FROM NEBRASKA
Senator JOHANNS. Mr. Chairman, thank you.

And to the team that is here today on behalf of the Veterans Administration, let me just say, welcome; we are glad to have you
here.
Mr. Secretary, thank you. You stopped by a couple weeks ago,
and that is always appreciated. So, I want to thank you publicly
for making that effort.
In the past years, as we all know, Congress has made the VA a
priority, and I believe appropriately so. The budget has been provided and there have been personnel increases. In some departments in the Federal Government, that is unheard of, but I think
it indicates this Committees commitment to our veterans and the
commitment of the Congress to our veterans.
Quite honestly, I doubt that this year will be any different. I
think, again, veterans will be a priority, and we will make sure
that that happens.
Now, having said thatbecause I think that is on the good news
piece of the equationthere are still challenges that we face. I do
not think anybody in this hearing today is going to make the case
that we are doing a great job in terms of the list to get disability
ratings and get people an answer, which is really what we are trying to do, get people information.
I keep hoping that we find that we are making progress. I hope
your testimony will deal with that issue, but the claims backlog is
a concern to all of us. It is not a partisan issue. It is a very, very
bipartisan concern.
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The other thing that I am hoping there will be some discussion
about is capital improvements. I scratch my head about this. And,
Mr. Secretary, no reflection on you, but we have a project in
Omaha, probably like other places around the United States, that
is waiting for good news that we are moving up the list. Every time
I meet with you, we slip further down.
So, I am not saying there is a correlation. I am just saying, gosh,
it is frustrating for us. So, I am hoping to hear your thoughts on
that.
I just think we are going to have to be creative in this area. I
think you get near the bottom of the list, and these are still 1940s
50s facilities that are outdated. We have great employees trying to
do the best they can under the circumstances, but at the end of the
day, some of the folks near the bottom are going to be waiting a
long time.
I may not live long enough to see this, but I would like to see
something creative to try to deal with that backlog.
Again, thank you for being here. I know you come here with
hearts that are pure. You want to help the veterans just like we
do, and maybe we can have a good dialog on how best to do that
in some of these areas.
Mr. Chairman, thank you.
Senator Tester.
STATEMENT OF HON. JON TESTER,
U.S. SENATOR FROM MONTANA
Senator TESTER. Thank you, Mr. Chairman.

I want to welcome everybody from the Veterans Administration
here today, too.
I do not have my reading glasses, so all the beautiful notes that
my staff wrote for me to tell you guys wont be read. [Laughter.]
So, you are going to hear what I have to say. OK?
I think the backlog issue is always a big issue. You know, we
helped create that in Congress by doing the right thing a few years
back with the Vietnam Vets.
General Shinseki, having visited with you several times, I know
it is a high priority for you. We will keep working on it; and this
Committee is committed to help you get that backlog down.
Staffing. I talked with Under Secretary Petzel a day or two ago
about this issue. It is critically important in rural America. We are
deficient. I think you guys are on top of it. We just need to make
sure we get some things done in that area.
I want to say a special thanks to Steve Muro. Thank you very
much, Steve, for your work on cemeteries. It is a very, very important issue across the country, and I think you have done some
great work.
Mental health. It may be the biggest issue this country faces,
whether you are in the military or you are out, but it is absolutely
a critical issue in the military, and we need to figure out how we
can handle it.
It is very expensive, but we need to do everything we can do,
whether it is best practices or whether it is just plain, old experts
in the field, to be able to develop partnerships, to be able to make
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sure that we give our veteransas you guys have heard from me
before, particularly in rural America, that those veterans need
help. They are isolated anyway. It is a big issue, and we need to
work together to get that done.
Construction. I would just say that I understand, and I think
that you guys have done a great job on the CBOCs and the Vet
Centers and those things around the country. I think that there is
opportunity for some advancement there. But I think you are dealing with operations and maintenance issues right now in many of
your buildings, getting them up to snuff so that the potential for
things like the veterans home in Butte, MT, does not hit the list.
I appreciate that prioritization, but I certainly would look forward to working together with you guys and through the Appropriations Committee to figure out some way in which we can address some of these senior veterans who served this country so very
well in the military and in the private sector that need and deserve
a place to live their later years.
Next, I say thank you to the VSOs that are in the roomthank
you guys very, very much for your input to us regarding the VA.
They are not perfect. There are things that they have to do, but
I think it is through the leadership of the VSOs that we are able
to advocate on the issues that you think are important.
And the one other issue I am going to talk about is advanced appropriations. I think that is a big win for the VA, and it would not
have had happened without the veterans service organizations all
being on the same page.
Thank you, Mr. Chairman.
Chairman SANDERS. You did very well without your staff notes.
Senator Hirono.
STATEMENT OF HON. MAZIE HIRONO,
U.S. SENATOR FROM HAWAII
Senator HIRONO. Thank you, Mr. Chairman.

I want to add my thanks to that of the Members of this Committee. All of us are very much in support of the priorities, Mr. Secretary, that you have articulated.
Certainly, increasing access to VA benefits, cutting or eliminating the backlog to claims, ending homelessness, the mental
health issues, the suicide ratesthese are all areas that we have
bipartisan support on the Committee.
Of course, Hawaiian veterans face many of the same challenges
that veterans across the country face, and add to that the fact that
our veterans arethe distance is water, not just land, as they live
on all of our major islands.
I think it is really important to focus on the issue of veteran
homelessness. I recently visited the VET house in Kalihi. I think
it is an area of our community that, Mr. Secretary, you know.
But, on the issue of homelessness, the support that we give to
programs such as the Veterans Engaged in Transition, VET,
houses, I think really hold promise.
So, this VET house that I visited is an eight-bedroom home in
a community in Kalihi. What very much impressed me was that
this was a situation where the veterans that were homeless are in
transitional housing. They have places to go after they spend their
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90 days in a stable environment because a lot of the homeless veterans do not have that stability in their lives. So, just to have a
calm, supportive place for a period of time to enable them to get
on with their lives is what I saw in this VET house.
This particular house was created by a non-profit entity in partnership with money from a grant from the VA of $233,000. They
worked with the Institute of Human Services, which is a non-profit
organization in Hawaii that works to provide shelter for the homeless. So, they are in the community.
The Lions, the Elks Club, other individuals and entities, including Home Depot, by the way, which as a company has made a huge
commitment, as I am sure you know, to support veterans programs, but to supply beds and all of that, and then the bedrooms
were adopted by these community organizations.
It was a terrific combination of people coming together, but it
also would not have happened without the money from the VA
grant.
So, these are the kinds of programs that I very much support as
hands-on. And, yes, it is aid to veterans, but I figureyou know
what? Each one that we help to get on in a positive way with their
lives, that is worth doing.
So, I just wanted to let you know that every time I go home, as
I am sure my colleagues do, we visit with veterans, which I did
when I was home a couple weeks ago.
Thank you very much for your service.
Of course, I look forward to working with my colleagues to make
sure that we provide the kind of support that will enable us to
meet the challenges of our veterans.
Chairman SANDERS. Thank you very much, Senator Hirono.
We may have some votes soon. So, we are going to have to juggle
things, and people will be leaving and coming.
So, let me begin and request short answers from the panelists.
Oh, testimony. I knew I forgot something. You probably wanted
to say something, right?
Secretary SHINSEKI. I will try to be short in light of the
Chairman SANDERS. Take your time. I am sorry.
Secretary SHINSEKI [continuing]. Very supportive comments
made by all the Members here today.
STATEMENT OF HON. ERIC K. SHINSEKI, SECRETARY, U.S. DEPARTMENT OF VETERANS AFFAIRS; ACCOMPANIED BY HON.
ROBERT A. PETZEL, M.D., UNDER SECRETARY FOR HEALTH;
HON. ALLISON A. HICKEY, UNDER SECRETARY FOR BENEFITS; HON. STEVE L. MURO, UNDER SECRETARY FOR MEMORIAL AFFAIRS; STEPHEN W. WARREN, EXECUTIVE IN
CHARGE FOR INFORMATION AND TECHNOLOGY; AND
HELEN TIERNEY, EXECUTIVE IN CHARGE FOR THE OFFICE
OF MANAGEMENT AND ACTING CHIEF FINANCIAL OFFICER
Secretary SHINSEKI. Chairman Sanders, Senator Isakson, and

other Members of the Committee, thanks for this opportunity once
again to present the Presidents 2015 budget and 2016 advance appropriations requests for the Department of Veterans Affairs.
I am working my sixth budget cycle. I find that almost incredible
to understand, but it is the sixth budget cycle for me.
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Together all of us here have accomplished a lot, and I deeply appreciateall of us appreciateyour unwavering support of our Nations veterans. It does not just occur in testimony. It occurs day
to day as we engage with you.
Let me also acknowledge, as others have, the representatives of
our veterans service organizations who are here today. Their insights and support make us better at our mission, caring for veterans and families and survivors.
Mr. Chairman, I am going to take a few seconds just to introduce
the members of my panel here. To my extreme left is Stephen Warren, the Executive in Charge for Information and Technology. Next
to him is Helen Tierney, VAs Executive in Charge of the Office of
Management, and she is also our Acting Chief Financial Officer. To
my right, Dr. Robert Petzel, Under Secretary for Health, and then
Allison Hickey, Under Secretary for Benefits, and to her right,
Steve Muro, Under Secretary for Memorial Affairs.
Mr. Chairman, I do have a written statement. I ask that it be
included in the record.
Chairman SANDERS. Without objection.
Secretary SHINSEKI. Thank you, Mr. Chairman.
The fiscal year 2015 budget and fiscal year 2016 advance appropriations requests demonstrate once again President Obamas
steadfast commitment to our Nations veterans. His leadership, the
support of the Congress, especially this Committee, have allowed
us for 5 years now to answer President Lincolns charge from 149
years ago, To care for him who shall have borne the battle and
for his widow and his orphan.
I thank the Members for your commitment to veterans and seek
once again your support of these budget requests.
The Presidents vision reflected in these requests is about empowering veterans to help lead the rebuilding of the middle class
in this country, much as they did after World War II, through access to quality health care, through benefits, through education and
training, the original GI Bill, and then employment that enabled
achieving the American dream.
The VAs 2015 budget request seeks $163.9 billion$68.4 billion
of that amount is in discretionary funding, including medical care
collections, an increase of 3 percent above our 2014 enacted funding level, this years budget.
It also $95.6 billion in mandatory funding.
This budget also requests $58.7 billion for the fiscal year 2016
advance appropriations for medical care, an increase of $2.7 billion,
or 4.7 percent, above the fiscal year 2015 request that I am also
submitting today.
It is another strong budget, and your support of it is critical to
providing veterans the care and benefits they have earned through
their service and sacrifice.
It enables VA to further the significant progress our Department
has already made on the top three priorities we outlined years ago
and have been working at during this intervening time. One is to
expand veterans access to benefits and services; second, eliminate
the disability claims backlog in 2015, as has been mentioned by a
number of members; and then, third, end the rescue of homeless
veterans in 2015.
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Since 2009, we focused the resources you provided to address
these three key priorities, among other requirements, but these
three priorities, to best serve veterans.
I would say, in terms of access, here is what we have accomplished:
More than two million additional veterans have been enrolled in VA health care.
We opened our 151st hospital, the first in 17 years, and we
have increased our community-based outpatient clinics by 55,
bringing our total to 820 community-based outpatient clinics
today.
More than a million veteran family members and students
have received VA educational assistance and vocational training.
Nearly 90 percent of all veterans today have a burial option
within 75 miles of where they live, thanks to Steve Muros
great work. We expect that that will increase out through
2017. We have plans to do that, at which point we will be at
the 96th percent mark.
In terms of disability claims, the backlog has declined 40
percent in the past 12 months. We are transitioning from
paper to digital processing, and we are on track to end the
backlog in 2015.
In terms of veterans homelessness, the estimated number of
homeless veterans fell by 24 percent between 2010 and 2013,
and we expect another reduction when this years point-in-time
count is finally tallied up.
These are some of our key accomplishments.
I would also report to the Committee that our momentum is up,
we are making good progress across the board, and, as I have in
each of my appearances here, assure you that we will continue to
leverage every resource of the budgetmoney, time, peopleto do
what is right for veterans.
As I have for 5 years now, I will assure you that we will use
these resources that the Congress provides effectively, efficiently,
and accountably to best care for veterans.
Again, thank you for this opportunity to appear here today and
for your continued support of veterans. I look forward to your
questions.
Thanks, Mr. Chairman.
[The prepared statement of Secretary Shinseki follows:]
PREPARED STATEMENT OF HON. ERIC K. SHINSEKI, SECRETARY,
U.S. DEPARTMENT OF VETERANS AFFAIRS
Chairman Sanders, Ranking Member Burr, Distinguished Members of the Senate
Committee on Veterans Affairs: Thank you for the opportunity to present the Presidents 2015 Budget and 2016 advance appropriations requests for the Department
of Veterans Affairs (VA). This budget continues the Presidents historic initiatives
and strong budgetary support for Veterans, their families, and survivors. We value
the sustained support that Congress has demonstrated in providing the resources
and legislative authorities needed to honor our Nations promises to these unique
and special citizens. Let me acknowledge our partners here todaythe Veterans
Service Organizationswhose insight and support make us better at fulfilling our
mission.
After more than a decade of war, many Servicemembers are returning home and
making the transition to Veteran status. As the war in Afghanistan enters its final
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chapter, our work is more urgent than ever. The current generation of Veterans will
help to grow our middle class and provide a significant return on the Nations investments in them. The President fully supports Veterans and their families, and
by providing them the care and benefits they have earned, we pay tribute to the
sacrifices that Veterans have made for this Nation.
The 2015 Budget for VA requests $163.9 billion$68.4 billion in discretionary
funds, including medical care collections, and $95.6 billion in mandatory funds for
Veterans benefits programs. The discretionary request reflects an increase of $2.0
billion (3.0 percent) above the 2014 Budget level. The Budget also requests a 2016
advance appropriation for Medical Care of $58.7 billion, an increase of $2.7 billion
(4.7 percent) above the 2015 Budget. The Presidents 2015 Budget will allow VA to
operate the largest integrated healthcare system in the country, including nearly
1,750 VA points of healthcare and approximately 9.3 million Veterans enrolled to
receive healthcare; the ninth largest life insurance provider, covering both active
duty Servicemembers and enrolled Veterans; an education assistance program serving nearly 1.1 million students; a home mortgage program with a portfolio of over
2 million active loans, guaranteed by the agency; and the largest national cemetery
system that leads the Nation as a high-performing organization, with projections to
inter 128,100 Veterans and family members in 2015.
GROWING DEMAND FOR VA SERVICES AND BENEFITS
Long after conflicts end, VA requirements continue to grow, due to the substantial
needs of Veterans. VAs budgetary requirements arise from our Nations national security engagements, which are not within our control. As the President said on Veterans Day last November, when we talk about fulfilling our promises to our Veterans, we dont just mean for a few years; we mean now, tomorrow, and forever.
Over the next decade, the Department of Defense (DOD) predicts that military separations will approach three million. This growing population is demanding more
services from VA than ever before. Currently, 11 million of the approximately 22
million Veterans in this country are registered, enrolled, or use at least one VA benefit or service, and this number will undoubtedly continue to grow.
MEETING VAS TOP THREE GOALS
In 2015, our challenges are clear and significant. VA must deliver on the ambitious goals we established 5 years ago, which are to:
Increase Veterans access to VA benefits and services;
Eliminate the disability claims backlog in 2015; and
End Veterans homelessness in 2015.
The 2015 Budget is critical to VA meeting these goals. Without the proper level
of funding to meet the growing demand for benefits and services, investing in our
physical and Information Technology (IT) infrastructure to assure reliable access,
eliminating the disability claims backlog, and completing the rescue phase of ending
Veterans homelessness become even more difficult. VA remains committed to meeting these challenges and appreciates the continued support of the Congress.
STEWARDSHIP OF RESOURCES
At VA, we are committed to responsible stewardship, using resources effectively

and efficiently and aggressively identifying budget savings. Over the past three
years, we have averaged $1.6 billion annually in efficiencies and budget savings,
and in 2015, that commitment to budget efficiencies and savings is more than $2
billion. We are attentive to areas in which we need to improve our operations, and
are committed to taking swift corrective action to eliminate any practices that do
not deliver value for Veterans. For 15 consecutive years, VA delivered clean financial audits, during which time material weaknesses were reduced from four to one,
and in 2013, for the first time, we had no significant deficiencies, having eliminated
16 prior significant financial deficiencies. This is an area of major accomplishment
in our internal controls and fiscal integrity.
INFORMATION TECHNOLOGY
To serve Veterans as well as they have served us, we are working to deliver a
21st century VA that provides medical care, benefits, and services through a secure
digital infrastructure. IT affects every aspect of what we do at VA. It has a direct
impact on the quality of healthcare we provide Veterans; our ability to process
claims efficiently; and our ability to provide Veterans benefits and services. In 2013,
VA IT systems supported nearly 1,750 VA points of healthcare: 151 medical centers,
135 community living centers, 103 domiciliary rehabilitation treatment programs,
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820 community-based outpatient clinics, 300 Vet Centers, and 70 mobile Vet Centers. The corresponding increase we have seen in the medical care spending for
these facilities directly translates to new and increased services provided to Veterans. To provide Veterans access and benefits, we must make the necessary investments in IT innovations and deployments.
Our 2015 Budget requests $3.9 billion for IT, consisting of $531 million for development; $2.3 billion for sustainment; and $1 billion for more than 7,400 staff, most
of whom serve in VA hospitals and regional offices. The request will sustain our infrastructure while making necessary investments in critical business processes, such
as modernizing healthcare scheduling, streamlining benefits processing, enhancing
and modernizing VAs electronic health record, enhancing data security, and achieving health data interoperability with DOD.
Information security is a top priority at VA. The 2015 Budget requests $156 million for information protection and cyber security, an increase of $33 million (27 percent) over 2014. VA is constantly strengthening information security and improving
technology and processes to ensure Veteran data and VAs network are secure. Like
any organization, public or private, we must continue to adapt. Our security posture
is based on a defensein-depth approach, which includes our partners at the Department of Homeland Security who maintain an over watch on our exterior perimeter. Working inward from our firewalls, VA has additional layers and protections
that are constantly monitoring potential threats.
Technology is also a critical component for achieving our goal to eliminate the disability claims backlog in 2015. The 2015 Budget requests $137 million in IT funding
for the Veterans Benefits Management System (VBMS), including $44.5 million for
development and $92.5 million for sustainment. The 2015 development funds will
allow VA to electronically process disability compensation claims in VBMS, from establishment to award. Planned enhancements and increased automation will allow
end-users to focus on more difficult disability compensation claims by reducing the
time required to process less complex claims. Sustainment funds will support the
infrastructure behind VBMS as well as the deployment of additional new functionality features.
The 2015 Budget continues our progress toward evolving VAs VistA electronic
health record (EHR) and achieving seamless integration of health data with the
DOD by 2017. The budget requests $269 million to help achieve our shared goal of
providing the best possible support for Servicemembers and Veterans. In the near
term, we are working to create seamless integration of DOD, VA, and private provider health data. In the mid-term, we are working to modernize the software supporting DOD and VA clinicians. Together, these two goals will help to create an environment in which clinicians and patients from both Departments are able to share
current and future healthcare information for continuity of care and improved treatment. As we strive to build on our successful history of health data sharing and collaboration, we understand our EHR modernization efforts are complicated, dynamic,
and multi-faceted.
IMPROVING AND EXPANDING ACCESS TO BENEFITS AND SERVICES
The number of Veterans receiving VA benefits and services has grown steadily
and will continue to rise as overseas conflicts end and more Servicemembers transition to Veteran status. In 2015, the number of patients treated within VAs
healthcare system is projected to reach 6.7 million, an increase of nearly one million
patients (17.4 percent) since 2009. Within VBA, the number of Veterans and survivors receiving Compensation and Pension benefits will approach 5 million in 2015,
while the number of Education and Vocational Rehabilitation beneficiaries will exceed 1.1 million.
We continue to improve access to VA services by opening new, and improving current, facilities closer to where Veterans live. Since January 2009, we have added approximately 55 community-based outpatient clinics (CBOCs), for a total of 820
CBOCs, and the number of mobile outpatient clinics and Mobile Vet Centers, serving rural Veterans, has increased by 21, to the current level of 78. In addition, while
opening new and improved facilities is essential for VA to provide world-class
healthcare to Veterans, so too is enhancing the use of ground breaking new technologies to reach countless other Veterans. We continue to invest in taking the facility to the Veteranthrough expanded access to telehealth, sending Mobile Vet
Centers to reach Veterans in rural areas where certain services are limited or difficult to reach, and by deploying social media to connect with Veterans to share information on the VA benefits they have earned.
The Affordable Care Act (ACA) expands access to coverage, provides new ways to
bring down healthcare costs, improves the Nations healthcare delivery system, and
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has important implications for VA. VA is ensuring a coordinated and collaborative
approach to ACA implementation. We estimate that there are approximately 1.3
million uninsured Veterans, of which 1 million may be eligible for, but not enrolled
in VA healthcare. We will continue our education and outreach efforts so Veterans
know the healthcare law does not affect their VA health benefits or out-of-pocket
costs, and that Veterans enrolled in VA healthcare do not need to take additional
steps to meet ACAs new coverage standards. We will also encourage Veterans family members not enrolled in a VA healthcare program to obtain coverage through
the Health Insurance Marketplaces.
A large part of our Veteran population hails from the small towns of rural America. Some 3.1 million Veterans enrolled in VAs healthcare system live in rural or
highly rural areas, about 36 percent of all enrolled Veterans. In total, more than
$17.36 billion were obligated in 2013 for the health care needs of rural Veterans.
As technology advances and broadband access expands across rural America, we
have been able to extend the availability of VA healthcare through telemedicine,
web-based networking tools, and the use of mobile devicesall of which help improve access to care and support economic development for people in rural areas.
Telehealth is a transformative breakthrough in healthcare delivery in 21st century
medicine, allowing care to reach Veterans who otherwise may not have access, especially those who live in rural and extremely remote areas. The 2015 Budget requests
$72 million for Rural Health telehealth.
Changing demographics are driving transformation at VA. Women now comprise
nearly 15 and 18 percent of todays active duty military forces and Reserve component, respectively. Women are the fastest growing segment of our Veteran population. Since 2009, the number of women Veterans enrolled in VA healthcare increased by almost 29 percent, to 629,683. The 2015 Budget includes $403 million
for gender-specific healthcare services for women Veterans. Today, nearly 49 percent
of our facilities have comprehensive womens clinics, and every VA healthcare system has designated womens health primary care providers and a women Veterans
program manager on staff.
The Caregivers and Veterans Omnibus Health Services Act (Caregivers Act)
marked a major step forward in Americas commitment to those who provide daily
care for wounded warriors, who have borne the battle for us all. The sustainment
phase of the Caregivers program began in 2013, and includes application processing;
stipends; travel and healthcare coverage; education, training, and competency; and
IT support. The 2015 Budget includes $306 million for the Caregivers program, including $235 million for caregiver stipends.
Since VA began implementation of the Honoring Americas Veterans and Caring
for Camp Lejeune Families Act in August 2012, more than 10,100 Veterans have
contacted VA concerning Camp Lejeune-related treatment, as of February 27, 2014.
Of these, roughly 8,300 were already enrolled in VA healthcare. Veterans who are
eligible for care under the Camp Lejeune authority, regardless of current enrollment
status with VA, will not be charged a co-payment for healthcare related to the 15
illnesses or conditions recognized, nor will a third-party insurance company be billed
for these services. VA continues a robust outreach campaign to these Veterans and
family members while we press forward with implementing this law. The 2015
Budget includes $51 million to provide healthcare for Veterans and family members
who were potentially exposed to contaminated drinking water at Camp Lejeune.
The 2015 Budget requests $99.6 million in IT funding for the Veterans Relationship Management (VRM) initiative, which is transforming Veterans access to VA
benefits and services by empowering Veterans with new self-service tools. In addition, VRM is essential to achieving our access goals. We are transforming VAs national call centers into service centers by delivering enhanced, integrated, systemwide telephone capabilities. VBA is also implementing the Client Relationship Management Unified Desktop that provides Veterans or beneficiary contact history and
a consolidated view of benefit programs for our employees to enhance the customers
experience and provide responsive and complete information.
As part of this experience, VBA aggressively promoted eBenefits and improved
Veterans ability to enroll in and access VA benefits and services. The joint VA/DOD
eBenefits Web portal is a personalized central location for Veterans, Servicemembers, and their families to research, access, and manage their benefits and personal information. More than 3.2 million Servicemembers and Veterans are enrolled
in eBenefits, and our goal is to expand enrollment to 5 million users in 2015. Over
50 self-service features, including online filing of claims, online uploading of evidence, and claim status tracking are now available in eBenefits; VA and DOD continue to expand functionality with each quarterly release.
VA also continues to increase access to burial services for Veterans and their families through the largest expansion of its national cemetery system since the Civil
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War. At present, approximately 90 percent of the Veteran populationabout 20 million Veteranshas access to a burial option in a national, state, or tribal Veterans
cemetery within 75 miles of their homes. In 2004, only 75 percent of Veterans had
such access. This dramatic increase is the result of a comprehensive strategic planning process that efficiently uses resources to serve the greatest number of
Veterans.
IMPROVING ACCESS TO MENTAL HEALTH SERVICES
We have been a Nation at war for more than a decade, and the state of Servicemembers and Veterans mental health is a National priority. At VA, meeting the
individual mental health needs of Veterans is more than a system of comprehensive
treatments and services; it is a philosophy of ensuring that Veterans receive the
best mental healthcare possible, while focusing on the overall mental well-being of
each Veteran. VA remains committed to doing all we can to meet this challenge.
Through the strong leadership of the President and the support of Congress, Veterans access to mental healthcare has significantly improved. Some of the stigma
associated with seeking help has diminished. We proactively screen all Veterans for
PTSD, depression, TBI, problem drinking, substance abuse, and military sexual
trauma (MST) to identify issues early and provide treatments and intervention opportunities. We know that when we diagnose and treat people, they get better.
Rates of suicide among those who use VHA services have not shown increases similar to those observed in all Veterans and the general U.S. population. Since 2006,
the number of Veterans receiving specialized mental health treatment has risen
each year from 927,000 to more than 1.3 million in 2013. In addition, Outpatient
visits and encounters will increase to 12.8 million in 2015, from 12.1 million in
2013. Vet Centers are another avenue for mental healthcare access, providing services to 195,913 Veterans and their families in 2013.
While we made significant progress in serving the growing number of Veterans
seeking mental healthcare, our work is not done. The 2015 Budget includes $7.2 billion for mental healthcare, an increase of $309 million (4.5 percent). VA efforts are
crucial to dispel the lingering stigma surrounding treatment, and help Veterans regain their dignity and the ability to hold meaningful employment and maintain a
home, which helps, in turn, strengthen our Nations economy.
In response to the growing demand for mental health services, VA enhanced capacity and improved the system of care so that services are more readily accessible.
In 2012, VA completed a comprehensive assessment of the mental health program
at every VA medical center and is using the results of that assessment to improve
programs and share best practices across VISNs and facilities. VA also held mental
health summits at each of our 151 medical centers, broadening the community dialog between clinicians and stakeholders.
We are developing new measures to gauge mental healthcare performance, including timeliness, patient satisfaction, capacity, and availability of evidence-based
therapies. Evidence-based staffing guidelines are being written for specialty and
general mental health. In addition, VA is working with the National Academy of
Sciences to develop and implement measures and corresponding guidelines to improve the quality of mental healthcare. To help VA clinicians better manage Veteran
patients mental health needs, VA is developing innovative electronic tools. For example, Clinical Reminders give clinicians timely information about patient health
maintenance schedules, and the High-Risk Mental Health National Reminder and
Flag system allows VA clinicians to flag patients who are at-risk for suicide. When
an at-risk patient does not keep an appointment, Clinical Reminders prompt the clinician to follow up with the Veteran.
Since its inception in 2007, the VAs Veterans Crisis Line in Canandaigua, New
York, answered nearly 1,000,000 and responded to more than 143,000 texts and
chat sessions from Veterans in need. The Veterans Crisis line provides 24/7 crisis
intervention services and personalized contact between VA staff, peers, and at-risk
Veterans, which may be the difference between life and death. In the most serious
calls, approximately 35,000 men and women have been rescued from a suicide in
progress because of our interventionthe rough equivalent of two Army divisions.
ELIMINATING THE CLAIMS BACKLOG
VA has no greater responsibility than ensuring Veterans and their survivors receive timely, accurate decisions on their disability compensation and pension claims.
Too many Veterans have waited too long to receive their benefitsand this has
never been acceptable to VA, including the employees of VBA, over half of whom
are Veterans. To attack this longstanding problem, we launched a historic plan to
transform our people, processes, and technology. Our strategy advances VBAs tools,
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streamlines claims processes, trains its workforce, improves workload management,
and meaningfully enhances interaction with Veterans and stakeholders to deliver
more timely and accurate benefit decisions and services to Veterans and their families. Despite an escalating workload brought about by the correct decisions for Veterans on Agent Orange, Gulf War, and combat PTSD presumptionsand successful
outreach to Veterans informing them of their benefitswe are making steady
progress toward our goal of eliminating the disability claims backlog in 2015.
The 2015 Budget requests $2.5 billion for VBA, an increase of $28.8 million from
2014. VBA projects a beneficiary caseload of 5.1 million in 2015, with more than
$78.7 billion in disability compensation and pension benefits obligations. We expect
to process 1.5 million compensation and pension claims in 2015, up from 1.25 million claims in 2014, an increase of nearly 17 percent over 2014.
Through our claims transformation initiatives, the use of mandatory overtime,
and other innovative strategies, we are making real progress in reducing the disability claims backlog. As of March 8, 2014, the backlog stood at 368,829 claims,
down 242,244 (40 percent) from its highest point on March 25th, 2013. Additionally,
under its Oldest Claims Initiative that began in April 2013, VA provided decisions
to over 500,000 Veterans whose claims had been pending the longest. VA continues
to work closely with DOD, the Internal Revenue Service, the Social Security Administration, and our other Federal partners to identify electronic data-sharing opportunities and process reforms to streamline workflows and limit paper claims filing.
VBMS is key to VBAs transformation and success in meeting our 2015 goal. In
June 2013, VBA completed national deployment of VBMSsix months ahead of
scheduleproviding access to over 25,000 end-users. Approximately 80 percent of
VAs pending disability claims are in a digital format for electronic processing in
VBMS. Moving to a digital environment is critical. VA anticipates there will be approximately 250,000 new Servicemembers transitioning to Veteran status each of
the next 4 years, for a total of one million new Veterans added during the next four
years. As a result of our increased efforts to enable more Veterans to access the benefits they have earned and deserved, many of these Veterans are likely to file a
claim with VBA within the first year of separation.
The 2015 Budget includes $138.7 million for continued investment in the Veterans Claims Intake Program (VCIP), which converts paper claims into an electronic
format and enables electronic transfer of medical and personnel records. This electronic transfer is critical to creating the necessary digital environment for
populating the eFolders and supporting end-to-end electronic claims processing for
each stage of the claims lifecycle. Although VA continues to accept paper claims
from Veterans who are not familiar with or cannot access computer technology, VBA
is working with stakeholders to increase the number of claims submitted electronically. VBA now converts paper claims to electronic format as we receive them, saving time and effort and improving accuracy. As of December 2013, over 25,000
VBMS users could access 424 million electronic images converted from paper.
The 2015 Budget includes $94.3 million for the Board of Veterans Appeals (the
Board), which we are requesting as a new appropriation separate from the General
Administration appropriation. The Board provides direct service to Veterans and
their families by conducting hearings and issuing final appeals decisions. VA is actively pursuing initiatives to improve the appeals process and reduce wait times for
Veterans, including a Board-led initiative that pre-screens appeals to ensure that
the record is fully developed and ready for adjudication. The Board is also streamlining decision writing to increase output and efficiency. Expanded use of VBMS and
the eventual incorporation of appeals functionality in VBMS will save resources currently spent handling, accessing, storing, and transporting paper claims files between the Board and VBA Regional Offices. The Board completed major technological upgrades to its video teleconference (VTC) equipment and the Board now
conducts slightly over half of their hearings by video teleconference, a significant increase from 29 percent in 2009. We project appeals will increase to 72,786 cases in
2015, an increase of 12 percent from 2014s 64,941 cases.
ENDING VETERAN HOMELESSNESS
Every Veteran who has served America ought to have a home in America. We
made great progress toward achieving our goal to end Veteran homelessness in
2015. VA will use knowledge gained over the past four years to ensure robust prevention programs are in place for future years. The 2015 Budget request is essential
for VA to successfully achieve an end-to-the-rescue phase, and prevent future homelessness among Veterans at-risk in the years to come.
Since 2009, VA, together with our Federal, state, and local partners, has reduced
the estimated number of homeless Veterans by 24 percent. We have conducted over
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six million clinical visits with over 600,000 Veterans who were homeless, at-risk of
homelessness (including formerly homeless). In 2013 alone, VA served more than
240,000 Veterans who were homeless or at-risk of becoming homeless21 percent
more than the year before. Over the past four years, the Point-in-Time (PIT) count
of homeless Veterans declined steadily, despite challenging economic times. The PIT
count estimate of the number of homeless Veterans dropped from 75,609 in January 2009, to 57,849 in January 2013, a 24 percent decrease.
VAs programs constitute the largest integrated network of programs with components of homeless assistance in the Nation. They provide homeless Veterans with
nearly 80,000 beds or units, including permanent supportive housing through the
Department of Housing and Urban Development-VA Supportive Housing (HUDVASH) program; link Veterans with needed mental health and other medical care;
and provide supportive services and opportunities to reintegrate Veterans back into
the community and workforce. VAs cost-effective, evidence-based homeless programs produce large savings and cost avoidance in budgetary, social, and economic
terms. Using a Housing First strategy, VA relies on research that shows that placing homeless Veterans into Housing First reduces emergency room visits, other
forms of intensive hospitalization, and substance overdose. Medical care costs are
roughly three times as expensive for homeless compared to Veterans who are not
homeless.
Despite significant progress and important accomplishments, much work remains.
We estimate that between 2013 and 2015, approximately 200,000 Veterans will experience homelessness at some point in time. To reach our goal of ending Veteran
homelessness in 2015, the Budget requests $1.6 billion for VA homeless-related programs, including case management support for the HUD-VASH voucher program,
the Grant and Per Diem Program, the Supportive Services for Veteran Families
(SSVF) program, and VA justice programs. This represents an increase of $248 million (17.8 percent) over the 2014 Budget level. This budget supports VAs long-range
plan to end Veteran homelessness by emphasizing rescue for those who are homeless today, and prevention for those at risk of homelessness.
HUD-VASH provides permanent supportive housing to the most vulnerable of our
homeless Veterans. The 2015 Budget requests $374 million for HUD-VASH, an increase of $47 million (14 percent) over the 2014 Budget level. This funding will support nearly 3,500 case managers to provide intensive wraparound services to nearly
80,000 Veterans. These case managers provide an average number of 12 clinical visits per year to these Veterans to ensure that they remain in housing and do not
become homelessness again. Veterans in HUD-VASH are vulnerable; the majority
meets criteria for chronic homelessness, and suffers from serious mental illness,
substance use disorders, and chronic medical conditions. This partnership remains
the most responsive housing option available to VA and is a critical component of
our strategy to move homeless Veterans from the streets to a safe and stable home.
The Grant and Per Diem Program helps fund community agencies providing services to homeless Veterans with the goal of helping them achieve residential stability,
increase their skill levels and/or income, obtain greater self-determination, independent living, and employment as soon as possible. The 2015 Budget requests $253
million for the Grant and Per Diem Program, an increase of $3 million (1.1 percent)
over the 2014 Budget level. In 2015, the program will provide over 15,500 transitional housing beds to Veterans through partnerships with more than 650 projects.
VAs SSVF is a critical aspect of our strategy to prevent and end Veteran homelessness. This program provides both prevention and rapid rehousing services to
Veterans and family members. In 2013, SSVF successfully prevented over 60,000 atrisk Veterans and family members from falling into homelessness, and successfully
placed over 84 percent of homeless Veterans and family members into permanent
housing. In the last three years, VA awarded grants totaling $459.6 million to 324
community agencies in all 50 states, the District of Columbia, Puerto Rico, and the
Virgin Islands. SSVF grants to private non-profit organizations and consumer cooperatives provide a range of supportive services to include outreach, case management, assistance in obtaining VA benefits, and assistance in obtaining and coordinating other public benefits. In 2015, VA will deploy SSVF grants strategically to
target resources to communities with concentrations of homeless Veterans.
In addition, VAs Justice Programs, which facilitate access to needed VA treatment for Veterans in criminal justice settings such as Veterans Treatment Courts,
are an important prevention effort for homeless and at-risk Veterans. The goal of
these Courts is to divert those with mental health issues and homelessness risk
from the traditional justice system and give them treatment and tools for rehabilitation and readjustment. The first Veterans court was established in 2008 in Buffalo,
N.Y. By the end of 2013, there were 257 courts nationwide, positively affecting the
lives of 7,724 Veterans; VA serves Veterans in each of these courts. Many of the
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participating Veterans have avoided incarceration and the cycle of homelessness,
that often follows incarceration. The 2015 Budget requests $35 million for Veterans
Justice Programs, an increase of $1.5 million (4 percent) over the 2014 Budget level.
To increase homeless Veterans access to benefits, care, and services, VA established the National Call Center for Homeless Veterans (NCCHV). The NCCHV provides homeless Veterans and Veterans at-risk for homelessness free, 24/7 access to
trained counselors. The call center is intended to assist homeless Veterans and their
families; VA medical centers; Federal, state, and local partners; community agencies; service providers; and others in the community. In 2013, the National Call
Center for Homeless Veterans received 111,096 calls (38 percent increase over 2012)
and made 78,622 referrals to VA medical centers (55 percent increase over 2012).
The 2015 Budget requests $5.6 million for NCCHV, an increase of $1.7 million (45
percent) over the 2014 Budget level. VA has established 28 Community Resource
and Referral Centers (CRRC) to provide rapid assistance to homeless Veterans.
MULTI-YEAR BUDGET FOR MEDICAL CARE
Due to Congresss foresight, under the Veterans Health Care Budget Reform and
Transparency Act of 2009, VA includes a request for an advance appropriation for
its medical care budget. The legislation requires VA to plan its medical care budget
using a multi-year approach, which ensures that VA requirements are reviewed and
updated based on the most recent data available and actual program experience.
The 2015 medical care budget of $59.1 billion, including collections, will fund treatment to over 6.7 million unique patients, an increase of 4 percent over the 2013 estimate. Of those unique patients, 4.7 million Veterans are in Priority Groups 16, an
increase of more than 204,836 (4.5 percent). Additionally, VA anticipates treating
over 757,600 Veterans from the conflicts in Iraq and Afghanistan, an increase of
over 141,100 patients (23 percent) over the 2013 level. VA also provides medical
care to non-Veterans through programs such as the Civilian Health and Medical
Program of the Department of Veterans Affairs (CHAMPVA) and the Spina Bifida
Health Care Program; we expect this population to increase by over 42,600 patients
(6.3 percent), during the same period.
Based on updated 2015 estimates largely derived from the Enrollee Health Care
Projection Model, the 2015 Budget will allow VA to increase funding for programs
to end Veteran homelessness; continue implementation of the Caregivers and Veterans Omnibus Health Services Act; fulfill multiple responsibilities under the ACA;
provide for activation requirements for new or replacement medical facilities; and
invest in strategic initiatives to improve the quality and accessibility of VA
healthcare programs. The 2015 appropriations request includes an additional $368
million above the enacted 2015 advance appropriations level. Our multi-year budget
plan assumes that VHA will carry over a small percentage of unobligated balances
from 2014 into 2015 to ensure that funds are available at the beginning of the fiscal
year to cover any unforeseen costs.
The 2016 medical care budget of $61.9 billion, including collections, provides for
healthcare services to treat over 6.8 million unique patients, an increase of 1.5 percent over the 2015 estimate. The 2016 request for medical care advance appropriations is an increase of $2.9 billion, or 4.9 percent, over the 2015 budget request.
Medical care funding levels for 2016, including funding for activations, non-recurring maintenance, and initiatives, will be revisited during the 2016 budget process,
and could be revised to reflect updated information on known funding requirements
and unobligated balances.
MEDICAL AND PROSTHETIC RESEARCH
VA supports the Presidents national action plan to guide mental health research
across government, industry and academia, and develop more effective ways to prevent, diagnose, and treat mental health conditions like TBI and PTSD. VAs medical
research programs demonstrate the creativity and ingenuity of our Nations greatest
minds to help save Veterans lives, limit their incapacitation, and build a better
world for their families. Projects funded in 2015 will focus on identifying or developing new treatments for Gulf War Veterans, improving social reintegration following Traumatic Brain Injury, reducing suicide, evaluating the effectiveness of
complementary and alternative medicine, developing blood tests to assist in the
diagnosis of PTSD and mild Traumatic Brain Injury, and advancing genomic
medicine.
In 2015, Medical Research will be supported through a $589 million direct appropriation, and an additional $1.3 billion from VAs medical care program, Federal
grants, and non-Federal grants. Including Medical Care support, other Federal resources, and private resources, total funding for Medical and Prosthetic Research
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will be nearly $1.9 billion in 2015. VAs research program benefits Veterans, their
families, and the Nation.
INCREASING EMPLOYMENT OPPORTUNITIES FOR VETERANS
Under the Presidents leadership, VA, the Department of Labor, DOD, and the entire Federal Government made Veterans employment one of their highest priorities.
At VA, we led by example. We made great strides during the last five years and
remain committed to meeting our goal of 40 percent of VA employees being Veterans, compared to 32.4 percent currently. During 2013, 33.8 percent of all new
hires at VA were Veterans, including an impressive 78.5 percent of all new employees in our National Cemetery Administration (NCA).
We continue to work to ensure that all of Americas Veterans have the support
they need and deserve when they leave the military, look for a job, and enter the
civilian workforce. The interagency Employment Initiative Task Force, co-led by VA
and DOD, developed a new training and services delivery model to help strengthen
the transition of our Veteran Servicemembers from military to civilian life. Accordingly, the 2015 Budget includes $106 million to meet VAs responsibilities under the
Presidents Veterans Employment Initiative and the VOW to Hire Heroes Act. In
addition, the 2015 Budget includes $1 billion in mandatory funding over 5 years to
develop a Veterans Job Corps conservation program that will put up to 20,000 Veterans back to work over the next 5 years protecting and rebuilding America. Jobs
will include park maintenance projects, patrolling public lands, rehabilitating natural and recreational areas, and law enforcement-related activities. Additionally,
Veterans will help make a significant dent in the deferred maintenance of our Federal, state, local, and tribal lands, including jobs that will repair and rehabilitate
trails, roads, levees, recreation facilities, and other assets. The program will serve
all Veterans, but have a particular focus on post-9/11 Veterans.
Since 2009, VA provided over $31.8 billion in Post-9/11 GI Bill benefits in the
form of tuition and other education-related payments to cover the education and
training of more than 1 million Servicemembers, Veterans, family members, and
survivors. As part of this effort VBA launched an online GI Bill Comparison Tool
to make it easier for Veterans, Servicemembers, and dependents to calculate their
Post-9/11 GI Bill benefits and learn more about VAs approved colleges, universities,
and other education and training programs across the country. The GI Bill Comparison Tool provides key information about college affordability and brings together information from more than 17 online sources and 3 Federal agencies, including the
number of students receiving VA education benefits at each school.
VA is also now working with Student Veterans of America to track graduation
and training completion rates, and we expect a draft report by the end of 2014 to
quantify program outcomes. The Post-9/11 GI Bill continues to be a focus of VBA
transformation, as it implements the automated Long-Term Solution (LTS), VAs
end-to-end claims processing solution that utilizes rules-based, industry-standard
technologies for the delivery of education benefits. At the end of January 2014, we
had 68,215 education claims pending, 21 percent lower than the total claims pending the same time last year. The average days to process Post-9/11 GI Bill supplemental claims decreased by 9.1 days, from 16.1 days in September 2012 to 7 days
in January 2014. The average time to process initial Post-9/11 GI Bill original education benefit decreased by 15.3 days in the same period, from 32.5 days to 17.2
days.
CAPITAL INFRASTRUCTURE
The 2015 Budget requests $1.06 billion for VAs major and minor construction
programs, the same as the 2014 Budget level. The capital asset budget demonstrates VAs commitment to address critical major construction projects that directly impact patient safety and seismic issues and reflects VAs ongoing promise
to provide safe, secure, sustainable, and accessible facilities for Veterans. The request also reflects the current fiscal climate and the great challenges VA faces in
order to close the gaps identified in our Strategic Capital Investment Planning
(SCIP) process.
Major Construction
The major construction request in 2015 is $561.8 million. The request provides
funding for four on-going major medical facility projects. They include: (1) seismic
corrections to renovate building 205 for homeless programs at the West Los Angeles,
CA VA Medical Center; (2) seismic corrections and construction of a new mental
health facility and parking structure at the Long Beach Healthcare System; (3) construction of a new community living center (CLC), domiciliary and outpatient facil-
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ity in Canandaigua, NY; and (4) construction of a new spinal cord injury/CLC facility, hospice nursing unit, and upgrades to a high-risk seismic building in San Diego,
CA. These projects represent VAs most critical major construction projects and correct critical safety and seismic deficiencies that are currently putting Veterans, VA
staff, and the public at risk. Once the projects are completed, Veterans seeking care
will be served in more modern and safer facilities.
The 2015 Budget also includes $2.5 million for NCA for advance planning activities and $7.5 million for land acquisition to support the establishment of 5 additional national cemeteries in Cape Canaveral and Tallahassee Florida; Omaha, Nebraska; southern Colorado; and western New York to meet the burial access policies
included in the 2011 budget.
Minor Construction
The 2015 Budget includes a minor construction request of $495.2 million. The requested amount would provide funding for ongoing and newly identified projects
that renovate, expand, and improve VA facilities. This years focus is a balance between continuing to fund minor construction projects that we can implement quickly
to maintain and repair our aging infrastructure, while using major construction
funding to address life-threatening safety and seismic issues that currently exist at
multiple VA medical facilities.
Opportunity, Growth and Security Initiative
The Budget also includes a separate $56 billion Opportunity, Growth, and Security Initiative to spur economic progress, promote opportunity, and strengthen national security. This Initiative would increase employment, while achieving important economic outcomes in areas from education to research to manufacturing and
public health and safety. Moreover, the Opportunity, Growth, and Security Initiative is fully paid for with a balanced package of spending cuts and tax loophole
closers.
At the Department of Veterans Affairs (VA), the Opportunity, Growth, and Security Initiative will support capital investments essential to expanding and protecting
Veterans access to quality care and benefits. By providing an additional $400 million for the VA capital program, enactment of the Initiative will allow additional
progress in addressing the Departments highest priority capital needs, including a
major construction project to replace a seismically deficient research facility in San
Francisco, California.
NATIONAL CEMETERY ADMINISTRATION
The NCA has the solemn duty to honor Veterans and their families with final
resting places in national shrines and with lasting tributes that commemorate their
service and sacrifice to our Nation. We honor those individuals service through our
133 national cemeteries, which includes two national cemeteries scheduled to open
in 2015, 33 Soldiers lots and monuments, the Presidential Memorial Certificate program, and through the markers and medallions that we place on the graves of Veterans around the world. The 2015 Budget includes $256.8 million for operations and
maintenance to uphold NCAs responsibility for this mission, including funds to
open two new national cemeteries and to begin preparations for opening two National Veterans Burial Grounds.
NCA projects its workload will continue to increase. For 2015, we anticipate conducting approximately 128,100 interments of Veterans or their family members, and
maintaining and providing perpetual care for approximately 3.5 million gravesites.
NCA will also maintain 8,882 developed acres and process approximately 362,900
headstone and marker applications.
NCA maintains a strong commitment to hiring Veterans. Currently, Veterans
comprise over 74 percent of its workforce. Since 2009, NCA hired over 450 returning
Iraq and Afghanistan Veterans. In addition, NCA awarded 66.5 percent of contract
awards in 2013 to Veteran-owned and service-disabled, Veteran-owned small businesses. NCAs committed, Veteran-centric workforce is the main reason it is able to
provide a world-class level of customer service. NCA participated for the 5th time
in the American Customer Satisfaction Index (ACSI), sponsored by the Federal Consulting Group and Claes Fornell International (CFI) Group. In the 2013 review,
NCA received a score of 96 out of a possible 100, the highest score to date for any
organization in the public or private sector.
NCA continues to leverage its partnerships to increase service for Veterans and
their families. As a complement to the national cemetery system, NCA administers
the Veterans Cemetery Grant Service (VCGS), which provides grants to establish,
expand, or improve state and tribal Veterans cemeteries. There are currently 90
operational state and tribal cemeteries in 45 states, Guam, and Saipan, with five
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more under construction. Since 1980, VCGS awarded grants totaling more than
$566 million to establish, expand, or improve these Veterans cemeteries. In 2013,
these cemeteries conducted over 32,000 burials for Veterans and family members.
LEGISLATION
In addition to presenting VAs resource requirements, the 2015 Presidents Budget

also proposes legislative action that will benefit Veterans. These proposals build on
VAs legislative agenda transmitted in the First Session of the 113th Congress, as
part of the 2014 Presidents Budget. Let me highlight a few provisions: VA proposes
a measure that will allow better coordination of care when a Veteran also receives
other care at a non-VA hospital, by streamlining the exchange of patient information. Additionally, we propose allowing the CHAMPVA to cover children up to age
26, to make that program consistent with benefits conferred under the ACA. We
also are submitting a proposal that would modernize our domiciliary care program
by removing income-based eligibility restrictions.
To continue our priority to end Veteran homelessness, VA proposes increased
flexibility in the Grant and Per Diem program to focus on the transition to permanent housing. Also among our proposals is a measure that would allow VA to speed
payment of Dependency and Indemnity Compensation and other benefits to surviving spouses by eliminating the need for a formal claim when there already is sufficient evidence for VA to act. We greatly appreciate consideration of these and other
legislative proposals included in the 2015 Budget and look forward to working with
Congress to enact them.
SUMMARY
Since the founding of our great Nation, Veterans helped our country meet all challenges; this remains true today as Veterans help rebuild the American middle class.
At VA, we continue to implement the Presidents vision and transform VA into a
21st century leader of efficiency, effectiveness, and innovation within the Federal
Government. Our 2015 Budget supports Presidential priorities to always add value
to the Nation, boost economic growth, strengthen the middle class, and work sideby-side with Federal partners to eliminate unnecessary overlaps or redundancies.
Given todays challenging fiscal environment, this Budget focuses VA resources,
policies, and strategies on the most urgent issues facing Veterans and provides the
resources critical to expand access, eliminate the disability claims backlog in 2015,
and end Veteran homelessness in 2015. There is no greater mission than serving
Veterans. Again, thank you for the opportunity to appear before you today and for
your unwavering support of Veterans.
[VA responses to posthearing questions follows:]

RESPONSE TO POSTHEARING QUESTIONS SUBMITTED BY HON. BERNARD SANDERS TO
HON. ERIC K. SHINSEKI, SECRETARY, U.S. DEPARTMENT OF VETERANS AFFAIRS
BENEFITS PROGRAMS
Question 1. Provide the current performance standards for employees involved

with the processing of claims.
Response. Attached are the performance standards for the Veterans Service Representative (VSR) and Rating Veterans Service Representative (RVSR) positions.
Attachment 1
NATIONAL PERFORMANCE PLAN
RATING VETERANS SERVICE REPRESENTATIVE (RVSR)
(Excludes PMC and IDES RVSRs)
ELEMENT 1QUALITY (Critical)
The RVSR must consistently and conscientiously exercise sound, equitable judgment in applying stated laws, regulations, policies and procedures to ensure accurate information is disseminated to veterans and accurate decisions are provided on
all benefit claims administered by the Department of Veterans Affairs.
Fully Successful (Issue Based)
Experience level defined by time in position:
612 months:
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1318 months:
1924 months:
Over 24 months:

Indicator
A random selection will be made of an average of 5 end products per month regardless of number of issues decided. This includes completed cases and partial ratings to determine the accuracy of the originator. The selection of actions, while random, must reflect an appropriate mix of work performed by the employee throughout the month (i.e. not from a single day or single week).
If a routine review of a RVSRs work demonstrates the need for quality improvement, an expanded sample of 10 total end products per month will be reviewed for
quality purposes.
Once an error is found and recorded concerning a specific issue associated with
the claim (ex: effective date), no additional errors related to that issue should be
recorded (consistent with M214 under the Quality Review Structure for cascading
effect).
ELEMENT 2TIMELINESS (Critical)
Timely processing of veterans claims is of paramount importance as it highly correlates with customer satisfaction. The RVSR will operate in an efficient manner
to accurately finalize claims using all appropriate workload management tools and
processes.
RVSRs are responsible for the types of work respective to their assigned duties.
Extenuating circumstances and notification to the employees supervisor will be considered.
Timeliness of Workload Management (includes rating, non-rating and appeals)
Fully Successful
RVSRs must manage their workload in accordance with locally established workload management plans.
There will be no more than 3 instances of RVSR specific duties not being completed within locally established timeframes, or failure of employee to notify their
supervisor when cases cannot be worked within established timeframes and reasons
thereof during the evaluation period. An incident will not be called until after the
first notification of non-compliance of the above standard.
Indicators
1 VETSNET Operations Reports (VOR)
2 Local Tracking Reports
3 Supervisory Assignments and Observation
4 Folder Aging Reports
5 VACOLS Reports
ELEMENT 3OUTPUT (Critical)
Processes a minimum cumulative average number of weighted actions on rating
related end products and the following: EP 930 series, statements of the case, supplemental statements of the case, claims certified to BVA, hearing decisions, EP
290, 600, 095, 070, 172, 165.
Weighted action credit will be given based on number of issues completed per the
following:
12 issues completed: .5 weighted action
34 issues completed: 1 weighted action
59 issues completed: 1.5 weighted actions
Each additional 5 issues completed will be given .5 weight actions (i.e. 1014
issues completed: 2 weighted actions; 1519 issues completed: 2.5 weighted actions;
2024 issues completed: 3 weighted actions; et cetera)
Fully Successful
612 months: 1.5 weighted actions
1318 months: 2 weighted actions
Over 24 months: 3 weighted actions
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* RVSRs on the Special Operations team will have an additional .25 weighted actions added
to their output for each claim worked meeting special operations criteria to account for the complexity of these cases.
Indicators
VOR
ASPEN
VACOLS Reports
* Duplicate credit will not be allowed for self-correction of an RVSRs error.
** Leave, union time, and special projects or assignments pre-approved at the discretion of the
supervisor are considered deductible time. Unmeasured time, such as informal training, was
considered in developing the successful level and is not reportable deductible time.
ELEMENT 4TRAINING (Critical)

RVSR will stay abreast of current laws and regulations, work processes, policies
and procedures and computer applications in order to provide optimum service to
our veteran population.
RVSRs are encouraged to actively participate in developmental activities of self
and others. For example, this may include volunteering to conduct needed training,
mentoring and second signature reviews.
The RVSR will complete mandatory Core Technical Training Requirements
(CTTR) as outlined on a published training schedule and within specified deadlines.
It is the responsibility of supervisors to provide RVSRs with a training schedule
in advance so they can complete their training requirements. It is the responsibility
of the RVSR to complete all required training within established guidelines.
Performance under this element will be mitigated when the RVSRs supervisor
has not allotted sufficient time for RVSR to complete training requirements or if the
RVSR is not provided a schedule of available training and the deadline they are to
complete.
Fully Successful
Timely completion of nationally mandated training hours to include core requirements and mandated local training during evaluation period. Completes training
within assigned deadlines with no more than 1 violation during evaluation period.
Indicators
TMS
Supervisory Observation
ELEMENT 5Organizational Support (Non-critical)
Functions as a team member to enhance resolution of claims by work actions.
Maintains professional, positive, and helpful relationships with internal and external customers (to include fellow employees and all stakeholders) by exercising tact,
diplomacy, and cooperation.
Performance demonstrates the ability to adjust to change or work pressures, to
handle differences of opinion in a businesslike fashion, and to follow instructions
conscientiously. As a team member, contributes to the group effort by supporting fellow teammates with technical expertise and open communications and by identifying problems and offering solutions. Performance also demonstrates the ability to
effectively communicate in a courteous manner with internal and external customers (to include fellow employees and all stakeholders).
The RVSR provides information to veterans and claimants that is accurate, concise, complete and written in a non-adversarial, respectful manner that demonstrates courtesy and compassion. This information may be in the form of rating
decisions, written correspondence to claimants and other verbal communication with
claimants such as personal hearings.
Fully Successful: No more than 3 instances of valid complaints or incidents.*
* A valid complaint or incident is one where a review by the supervisor, after considering both
sides of the issue, reveals that the complaint/incident should have been handled more prudently
and was not unduly aggravated by the complainant. Disagreeing, per se, does not constitute
discourtesy. Valid complaints or incidents will be determined by the supervisor and discussed
with the employee.
Indicator
Verbal and/or written feedback from internal and/or external customers. Observations by a supervisor with the complaint documented.
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Attachment 2
VETERANS SERVICE REPRESENTATIVE (VSR)
(Excludes PMC and PCT VSRs)
The VSR must consistently and conscientiously exercise sound, equitable judgment in applying stated laws, regulations, policies and procedures to ensure accurate information is disseminated to Veterans and accurate decisions are provided on
Standard
Quality of Work
Successful Level
GS7:
GS9:
GS10:
GS11:
The accuracy rate during the evaluation period

(cumulative)
(cumulative)
(cumulative)
The accuracy rate for work produced during
equals or exceeds 93% (cumulative)
equals or exceeds 80%

the evaluation period
Indicators
A random selection will be made of an average of 5 actions per month regardless
of number of contentions claimed. Quality of action taken on each contention will
be evaluated. The selection of actions, while random, must reflect an appropriate
mix of work performed by the employee throughout the month (i.e. not from a single
day or single week).
If a routine review of a VSRs work demonstrates the need for quality improvement, an expanded sample of an average of 10 actions per month will be reviewed
for quality purposes.
The ASPEN checklist to be used will mirror the STAR worksheet and will include
a component on systems compliance, which will be considered a substantive error.
ELEMENT 2TIMELINESS/WORKLOAD MANAGEMENT (Critical)
Timely processing of Veterans claims is of paramount importance, as it is highly
correlated with customer satisfaction. The VSR will operate in an efficient manner
processes.
VSRs are responsible for the cycles/type of work respective to their assigned duties. If multiple timeliness sub-elements apply to a VSR (e.g. average days awaiting
award, non-rating, and corrective actions) they must meet the fully successful level
for all applicable sub-elements to be successful for the element.
Extenuating circumstances and notification to the employees supervisor will be
considered. An incident will not be called until after the first notification of noncompliance of the above standard.
Timeliness
Timeliness of Rating End Products (including EP 930 series)
Fully Successful: All grade levels must meet locally established timeliness requirements, which are to be derived from end of year station targets.
The percentage of claims in each cycle pending over the locally established cycle
goal must align with station goals for percentage of claims greater than 125 days.
Management for each station sets goals.
Cycle Times
a. Average Days Awaiting Development
b. Average Days Awaiting Evidence
c. Average Days Awaiting Award
d. Average Days Awaiting Authorization
Timeliness of Non-Rating & Control End Products (i.e. EPs 600, writeouts, 800
series)
Fully Successful: All grade levels must meet locally established timeliness requirements, which should be derived from station targets.
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Timeliness of Direct Services (i.e. IRIS, Congressional Inquiries, etc.)
Fully Successful: All grade levels must meet locally established timeliness requirements, which should be derived from station targets. There will be no more than
5 instances where the VSR fails to meet established timeliness, or failure of employee to notify their supervisor when cases cannot be worked within established
timeframes and reasons thereof.
Timeliness of Special Projects & Duties (i.e. Women Veterans Coordinators,
AEW Project, etc.)
Fully Successful: There will be no more than 3 instances of tasks not being
worked within established timeframes, or failure of employee to notify their supervisor when cases cannot be worked within established timeframes and reasons
thereof.
Timeliness of Corrective Actions
Fully Successful: There will be no more than 3 instances of failure to complete
a returned corrective action, or failure of employee to notify their supervisor when
cases cannot be worked, within three days of the case being returned to them for
correction.
Workload Management
Fully Successful: All grade levels must manage their workload in accordance with
locally established workload management plans. There will be no more than 2 instances where the VSR fails to show compliance with established workload management procedures.
Local management will be responsible for creating and communicating a workload
management plan that will identify the types of work to be completed.
Indicators
VETSNET Operations Reports
Local Tracking Reports
Fully Successful: VSRs process a minimum cumulative average number of outputs
per day. Outputs will be counted as follows:
Development (Initial Development, Subsequent Development, and Ready for Decision including rating Eps, EP 930s, administrative decisions, appeals, non-rating
Eps, and EP 600s).7
12 contention claim development (Initial Development, Subsequent Development, and Ready for Decision including rating Eps, EP 930s, administrative decisions, appeals, non-rating Eps, and EP 600s).5
Telephone development.1
Process award/decision (generate award, clear end product).7
Authorize award.33
Note 1: Subsequent development includes any actionable item, which moves the
claim forward and is subject to quality review.
Note 2: Telephone development requires contact with claimant, representative, or
medical facility to further the development of the claim. Credit for telephone development may be taken in addition to development credit.
Note 3: VSRs performing Post-Determination authorization duties will receive an
additional .5 weighted action for more complex cases involving out of system payments or retroactive effective dates preceding 1982 (earliest generate line in
VETSNET).
Successful Level
GS7: 4
GS9: 5
GS10: 5.5
GS11: 6
Indicators
VOR
ASPEN
There will be no output element expectation for 90 days following the completion
of challenge training regardless of entry grade.
Duplicate credit will not be allowed for self-correction of a VSRs error.
Leave, union time, and special projects or assignments pre-approved at the discretion of the supervisor are considered deductible time. Unmeasured time, such as in-
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formal training, was considered in developing the successful level and is not reportable deductible time.
VSR will stay abreast of current laws and regulations, work processes, policies
our Veteran population.
Employees are encouraged to actively participate in self-developmental activities.
Performance for this standard will be mitigated when the VSRs supervisor has
not allotted sufficient time for VSR to complete training requirements or if the VSR
is not provided a schedule of available training and the deadline they are to
complete.
It is the responsibility of supervisors to provide VSRs with a training schedule
in advance so they can complete their training requirements.
Successful Level
GS7/9/10/11: Timely completion of nationally mandated training hours to include
core requirements and mandated local training during evaluation period. Completes
mandatory training within assigned deadlines with no more than 1 violation during
evaluation period.
Indicators
TMS
Functions as a team member to enhance resolution of claims and customer service
contacts by work actions. Maintains professional, positive, and helpful relationships
with customers by exercising tact, diplomacy, and cooperation.
effectively communicate in a courteous manner with customers during the personal
or telephone interview process.
Successful Level
GS7/9/10/11:
No more than 3 instances of valid complaints or incidents.*
* A valid complaint or incident is one where a review by the supervisor, after considering both sides of the
issue, reveals that the complaint/incident should have been handled more prudently and was not unduly aggravated by the complainant. Disagreeing, per se, does not constitute discourtesy. Valid complaints or incidents will be determined by the supervisor and discussed with the employee.
Indicators
Verbal and/or written feedback from internal and/or external customers
Observations by a supervisor with the complaint documented
Question 2. Provide the number of FTE at each VA regional office, separated by
job title and grade as of March 12, 2014.
Response. The attached spreadsheet provides full-time equivalent (FTE) employees by regional office (RO), grade, and position.
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Question 3. Provide the methodology utilized to allocate personnel and resources

to the regional offices and specifically address any refinements made to this methodology in the past fiscal year.
Response. The Veterans Benefits Administrations (VBA) Resource Allocation
Model (RAM) is a systematic approach to distributing field resources each fiscal
year. The RAM utilizes a weighted model to assign compensation and pension (C&P)
FTE resources based on RO workload, including rating inventory and rating, nonrating, and appeal receipts. Starting in fiscal year (FY) 2014, the RAM includes additional variables to more closely align with VBAs transformation to a paperless,
electronic environment, where receipts can be assigned and managed at the national
level. These variables include station efficiency, quality, and RO capacity. VBA leaders use the model as a guide, making adjustments for special circumstances or missions performed by individual ROs. Special missions include Day-One Brokering
Centers, Integrated Disability Evaluation System (IDES) processing sites, Benefits
Delivery at Discharge sites, Quick Start processing locations, and National Call
Centers (NCC). Non-payroll and travel resources are allocated to each RO based on
business need, including the number of FTE, benefit programs administered, and
other unique factors such as geographic location and jurisdiction.
Question 4. In 2009, VA began an effort to update the VA Schedule for Rating
Disabilities.
a. Provide an itemized list of funding expended in FY 2013 on the rating schedule
modernization.
Response. In FY 2013, VBA spent approximately $981,000 to support updates to
the VA Schedule of Rating Disabilities (VASRD), including $902,000 for personal
services, $30,000 for travel, and $49,000 for rent, supplies, and other services.
b. Provide an itemized list of funding expended in FY 2014 on the rating schedule
modernization.
Response. In FY 2014, VBA will spend approximately $996,000 to support updates
to VASRD, including $947,000 for personal services, $3,000 for travel, and $46,000
for rent, supplies, and other services.
c. Provide an itemized list of the requested funding in FY 2015 for the rating
schedule modernization. Also, include the number of FTE assigned to or supporting
this modernization effort.
Response. In FY 2015, VBA requested $3.0 million to update the VASRD, including $952,000 for personal services, $30,000 for travel, and $2.0 million for rent, supplies, and other services. The increase in funding in FY 2015 is primarily due to
a contracted earnings loss studies. Five employees are currently assigned to support
the VASRD update project.
d. Provide the Project Management Plan, the VASRD Update Operating Plan and
project schedule for the rating schedule modernization.
Response. The Project Management Plan for the VASRD Update Project, which
contains the operating plan and project schedule, is attached.
e. Does the FY 2015 request include any funding to support updates that will
need to be made to IT solutions, including VBMS, disability benefit questionnaires,
42
rules-based calculators, or other initiatives based on the current VASRD? How much
funding does VA anticipate these updates will require upon publication of final rules
for the various body systems?
Response. The FY 2015 budget request does not include funding to change information technology (IT) systems related to the VASRD modernization project, as
VBA does not plan to publish the proposed regulations until the fall of 2015. Consequently, any changes necessitated by the new regulations will not be required
until FY 2016.
Question 5. Provide the number of FTE assigned to or supporting VAs accreditation program. Also, provide the following information for calendar years 2012 and
2013.
a. The number of individuals per year who have sought recognition to represent
individuals before VA broken down by representatives of service organizations, attorneys or agents.
Response. As of April 2014, the Office of General Counsel has approximately 4
full-time equivalent employees (FTE) dedicated to the accreditation program:
3 FTEs for 3 legal assistants
Approximately 0.1 FTE for an Assistant General Counsel
Approximately 0.4 FTE for a Deputy Assistant General Counsel
Approximately 0.5 FTE total for 10 staff attorneys
From fiscal years 2009 to 2013, Department of Veterans Affairs has annually received applications from approximately 2,400 individuals seeking accreditation as
Veterans Service Organization (VSO) representatives; 2,430 individuals seeking accreditation as attorneys; and 355 individuals seeking accreditation as claims agents.
The estimate for VSO representatives includes requests for cross-accreditation,
which occur when an individual seeks accreditation through other organizations by
virtue of his or her membership of and accreditation through another organization.
(Please note that the data provided in the responses to Question 5 are approximations due to database limitations.)
b. Of those requests for recognition, how many were granted and how many were
denied?
Response. From fiscal years (FY) 20092013, Department of Veterans Affairs (VA)
has annually granted accreditation to approximately 2,390 Veterans Service Organization (VSO) representatives; 2,410 attorneys; and 65 claims agents. Because many
VSO representatives seek cross-accreditation with other organizations, the estimate
for VSO representatives does not reflect the total number of individual VSO representatives granted accreditation.
From FYs 2009- 2013, VA has annually denied accreditation to roughly 10 VSO
representatives, 20 attorneys, and 290 claims agents. Many claims agent applicants
are not granted accreditation because they do not take or pass the VA accreditation
examination or otherwise fail to pursue their application. Also, applicants may have
been denied because they were Federal employees, who are generally prohibited
from representing individuals before a Federal agency.
c. On average, how long does it take VA to process a request for recognition?
Response. As of April 2014, applications for accreditation of Veterans Service Organization representatives are processed in about 6090 days; attorney applications
in about 90120 days; and claims agent applications in about one year. Claims
agent applications take considerably longer because claims agent applicants need to
take and pass a Department of Veterans Affairs accreditation examination, submit
character references, and undergo a background check.
d. How many individuals had their recognition suspended or canceled?
Response. From fiscal years (FY) 20082013, Department of Veterans Affairs (VA)
suspended accreditation for cause for 3 Veterans Service Organization (VSO) representatives, 0 attorneys, and 0 claims agents.
From FYs 20082013, VA canceled accreditation for cause for 18 VSO representatives, 1 attorney, and 1 claims agent.
Other accredited VSO representatives may have had their accreditation canceled
by their organizations for various reasons, such as termination of employment, retirement, or failure to comply with the organizations training requirements. Other
accredited attorneys and claims agents may have had their accreditation suspended
in 2011 for failure to comply with VAs training requirements.
e. How many complaints were filed against individuals who are recognized to represent claimants before VA, how many were found to have merit, and how many
were referred to the Inspector General, a law enforcement agency, or other similar
enforcement entity and how many of the referred cases resulted in further enforcement, disciplinary or legal action?
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Response. Since January 2012 (Department of Veterans Affairs (VA) does not
have complete numbers prior to 2012 because the database did not track complaints
before 2012), VA received approximately 60 complaints8 complaints regarding accredited Veterans Service Organization (VSO) representatives, 19 complaints regarding accredited attorneys, 10 complaints regarding accredited claims agents, and
23 complaints regarding non-accredited individuals or organizations. In about 20 of
these complaints, Office of General Counsel (OGC) found the matter not to have
merit, or OGC did not receive the necessary disclosure authorizations to follow up
on the complaints. VA followed up on approximately 40 of the 60 complaints. Currently, there are approximately 30 complaints that are in pending or monitoring
status.
In two instances, VA initiated cancellation proceedings against two accredited attorneys for unlawful practices. These two matters are currently awaiting a VA administrative hearing. In two other instances, accredited attorneys refunded to Veterans fees that were allegedly charged unlawfully. In five instances, accredited individuals changed their business policies or practices.
Since 2009, VA has referred approximately 7 accreditation matters to State Attorney General Offices. In one instance, a State Attorney Generals Office prosecuted
a non-accredited individual engaged in unlawful activities involving VA benefit
claims for violation of State consumer protection laws. This matter is currently
pending with a State administrative hearing judge.
VA/DOD COLLABORATION
Question 6. According to the FY 2015 budget request, the Integrated Disability

Evaluation System (IDES) operates at 139 military treatment facilities worldwide
and is available to all servicemembers who are referred to medical evaluation
boards for fitness determinations. The FY 2015 budget request noted 31,764 new referrals in 2013.
a. Has DOD provided VA with information on the anticipated number of referrals
that VA can expect the program to receive in FY 2015 or future fiscal years?
Response. Projections were provided by the Department of Defense (DOD). The
total of 93,868 follows:
FY 2015: 27,213
FY 2016: 24,194
FY 2017: 21,195
FY 2018: 21,266
b. How many referrals has the program received in FY 2014 and how many are
anticipated in FY15?
Response. The Department of Veterans Affairs (VA) total for FYs 2014 and 2015
were 57,803, and below is the breakdown.
Projected referrals for FY 2014: 30,590 (Actual referrals through March 2014:
14,475)
Anticipated referrals for FY 2015: 27,213
c. How many contract disability examinations were used to support IDES in FY
2013 and to date in FY14?
Response. VAs total for FYs 2013 and 2014 were 24,717 and below is the breakdown:
Veterans Health Administration (VHA)VHA provided 2,123 exams in FY 2013
and 474 in FY 2014.
Veterans Benefits Administration (VBA)In FY 2013, 15,142 VBA contract examinations were completed in support of Integrated Disability Evaluation System
(IDES).
FY 2014 through March 2014: 6,978 VBA contract examinations were completed
in support of IDES.
d. What specific actions have been taken to improve intra-agency information exchange processes to ensure VBA meets the benefit notification goal of 30 days?
Response. VA is taking the following actions to help meet the benefit notification
goal of 30 days for IDES claims:
VA must obtain verified service information before finalizing IDES awards.
DODs Defense Manpower Data Center sends this information to VA via the VA/
DOD Identity Repository (VADIR), and VA views the information using the Veterans Tracking Application. In March 2014, separation, severance, and retired pay
information from VADIR was made available on the Veterans Information Solution,
an intranet-based application designed to provide a consolidated view of information
about Veterans and Servicemembers.
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In coordination with the Providence Disability Rating Activity Site (DRAS), the
Navy has begun electronically submitting DD Form 214s for IDES participants for
final processing. This ensures the electronic form is available to VA shortly after
discharge and eliminates delays associated with untimely submission of DD Form
214.
The Physical Evaluation Boards have agreed to include an indication of the current duty status of members of the National Guard and Reserve along with the request for preliminary IDES ratings. This information allows the DRAS to immediately finalize and deliver benefits to IDES participants who are not in active-duty
status.
In April 2013, VA reviewed disability compensation payments based on disability discharges and disability retired pay. Based on this review, VA issued standard operating procedures for IDES cases in August 2013 that allow disability compensation payments to start without waiting for disability retirement payments to
begin and that do not result in the creation of an overpayment when retired pay
does begin. In addition, the Defense Finance and Accounting Services Retired Casualty Pay Subsystem completed a programming change in February 2014 that allows VA to more timely process an additional set of claims without incorrectly affecting retired pay.
e. Provide the amount of funding spent in FY 2013 and how many VA employees
were dedicated to the IDES process.
Response. VAs total for FY 2013 was $93,364,281 and below is the breakdown:
Office of Policy and Planning (OPP)During FY 2013, OPP spent approximately $1,164,281, which is comprised of $570,630 for a program management support contract, $568,651 in salary for 5 FTE, and $25,000 in travel costs.
VHAThe FY 2013 IDES Supplemental Budget distributed to the operational
field sites supporting the IDES Program was $21.5 million. These funds were distributed to VAMCs with a direct IDES mission to assist and defray costs associated
with the deployment and implementation of the IDES program. Staff located at VA
medical centers (VAMCs) are not solely dedicated to the IDES process.
VBADuring FY 2013, VBA spent approximately $70.7 million for salaries and
other general operating expenses for 643 FTE dedicated to disability claims processing in the IDES process. Compensation staff and Vocational Rehabilitation and
Employment counselors are included in this count. Veterans filing claims through
the IDES sites are captured in the nationwide Veteran caseload count and total
compensation benefit obligations; therefore, mandatory funding cannot be separated
for this program.
f. Provide the amount of funding spent in FY 2014 and how many VA employees
were dedicated to the IDES process.
Response. VAs total for FY 2014 was $73,092,082 and below is the breakdown.
OPPDuring FY 2014, OPP estimates it will spend $1,192,082, which is comprised of $581,144 for a program management support contract, $585,938 in salary
for 5 FTEs, and $25,000 in travel costs.
VHAIn FY 2014, supplemental funding for IDES was will no longer provided
to operational sites. IDES Supplemental funding was a VHA initiative inacted to assist facilities having an IDES mission, to assist them defray costs associated with
the deployment and implementation of the IDES Program. Once the IDES program
matured and was fully implemented, funding to assist with IDES operational costs
were included in VHAs Veterans Equitable Resource Allocation (VERA) model. Staff
located at VAMCs are not solely dedicated to the IDES process.
VBADuring FY 2014, VBA estimates it will spend approximately $71.9 million for salaries and other General Operating Expenses (GOE) to support 648 FTE
dedicated to disability claims processing in the IDES process.
g. Provide the amount of funding requested in FY 2015 and how many VA employees will be dedicated to the IDES process.
Response. VA total for FY 2015 was $75,297,179 and below is the breakdown.
OPPDuring FY 2015, OPP estimates it will spend $1,197,179 which is comprised of $586,241 for a program management support contract, $585,938 in salary
for 5 FTEs, and $25,000 in travel costs.
VHAStarting in FY 2014, supplemental funding for IDES was no longer provided to operational sites. IDES Supplemental funding was a VHA initiative inacted
to assist facilities having an IDES mission, to assist them defray costs associated
with the deployment and implementation of the IDES Program. Once the IDES program matured and was fully implemented, funding to assist with IDES operational
costs were included in VHAs VERA funding as described earlier.Staff located at
VAMCs are not solely dedicated to the IDES process.
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VBADuring FY 2015, VBA estimates it will spend approximately $74.1 million for salaries and other GOE to support 648 FTE dedicated to disability claims
processing in the IDES process.
Question 7. VAs Office of Interagency Collaboration and Integration is responsible
for coordinating the implementation of the Integrated Disability Evaluation System
(IDES) and streamlining the disability evaluation process through continual process
improvements.
a. What process improvements were made in FY 2014 to streamline the process?
Response.
IDES Process Improvements (FY 2014)

Improvement Initiatives
Impact
Current Status
Disability Benefit Questionnaires (DBQ) in IDES.
Decrease rates of inadequate medical exams and allow

digitalization of IDES med exam information for input
into Veterans Benefits Management System (VBMS).
DBQs implemented at all

IDES sites Oct. 1, 2013
VHA providers were placed at

the Regional Offices and
Disability Rating Activity
Sites.
Reduce time and insufficient reports

Clarify questions raised regarding the disability exam
[extra words to cause a runover line]
Allow for training points
Providers are currently located at the Seattle and

Providence sites.
VA Pays First .........................
VA will be able to pay separating Servicemembers without waiting 2025 days for the Defense Finance and
Accounting Service to complete accounting processes
for Retired Pay cases with a skeleton record in the
Recovery Care Program Support System.
Phase I and II have been

implemented and Servicemembers are no longer
waiting to receive pay.
b. What is the current status of electronic case file transfer capabilities within
IDES?
Response. Electronic case file transfer is currently pending the establishment of
a bi-directional interface between VAs Data Access Service to VBMS. As an interim
solution, VA and DOD are exploring alternative methods of sending an electronic
case file to VAs scanning vendor for upload into VBMS.
Question 8. The problem of overmedication and medication management is a national problem, one that both public and private health care systems must address.
VA has reported the Opioid Safety Initiative (OSI) conducted at eight sites in Minnesota was a success.
a. Provide the Committee with the results of the OSI conducted at the eight sites
in Minnesota.
Response. At the American Academy of Pain Medicines annual meeting on
March 7, 2014, Peter Marshall, M.D., from the Minneapolis VA Health Care System
presented a summary of methods and outcomes of the Minneapolis VA OSI to the
Veterans Health Administration (VHA) and DOD pain management leaders. The
Minneapolis OSI team is submitting a manuscript for publication in Pain Medicine
describing OSI methods and outcomes. These results include:
The number of patients prescribed high-dose (>200 Morphine Equivalent Dose
or MED) opioids for chronic, non-cancer pain has been reduced by 70 percent.
The number of patients prescribed >400MED opioids for chronic, non-cancer
pain has been reduced by 86 percent.
With reduced numbers of patients receiving high-dose opioids, the total
amounts of opioids supplied to the Minneapolis patient population (in MED) has
fallen by 50 percent.
There has been a 13 percent reduction in total number of unique patients who
received at least one opioid prescription in the past 30 days, while the total number
of unique patients went up by 10 percent. This may reflect a change in treatment
culture to use alternatives to opioids for treating chronic, non-cancer pain.
Annual urine drug screening (UDS) in patients on opioids for chronic non-cancer pain has increased from 21 percent to 55 percent of patients. For patients on
high-dose (>200MED), annual UDS has increased from 30 percent to 64 percent of
patients.
All other Veterans Service Integrated Network (VISN) 23 Health Care Systems
are adapting this model and are at various stages of implementation. Clinical pharmacists and Patient Aligned Care Teams (PACT) are highly engaged in using teambased approaches to support safe and effective care to their patients.
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b. Provide a detailed description of the opioid safety program in which all medical
centers are now participating.
Response. OSI is a comprehensive monitoring program to provide safe and effective pain care. Currently, all 21 VISNs and all VA medical centers (VAMC) are able
to access provider-specific opioid prescribing data through a unique business intelligence tool named the Opioid Safety Dashboard (OSD). OSD enables VISN and
VAMC subject matter experts trained in the safe use of opioids to assist providers
in maintaining safe prescribing practices. OSD identifies patients on potential unsafe combinations of medications (such as opioids and benzodiazepines) and those
who would benefit from closer monitoring of drug treatment through urine screening. This information is available for use by subject matter experts and providers.
OSD is updated quarterly to reflect new prescriptions and monitor current prescribing. Monitors include: the number of patients monitored using urine drug
screening, the number of patients on opioids and benzodiazepines, and the total
number of patients receiving opioids. This data is made available for review by subject matter experts, providers, and VISN and VAMC leadership. VHA Central Office
also develops trending reports that are reviewed by field-based pharmacy and clinical leadership.
Additionally, as part of the OSI, VHA Central Office has provided field-based staff
training materials that encourage the use of non-opioid medications and alternatives, which reinforce the use of complementary and alternative medicine as a
vital tool to provide safe pain care.
c. Provide a detailed description of the reasons for having all medical centers participate in an opioid safety program and what plans and procedures VA has to
measure the success of the program.
Response. One of the primary goals of VHA is to ensure that the care provided
to Veterans is safe, high-quality and evidence-based. VHA is implementing OSI system-wide to ensure that Veterans across the Nation have appropriate access to safe
prescribing of opioids, as this is a treatment modality that is broadly used across
VHAs health care system. VHA is utilizing OSD to monitor utilization of urine drug
screening, provider-specific prescribing of opioids and benzodiazepines, and the total
number of opioids prescribed. The intent of these monitors is to verify that Veterans
experiencing chronic pain receive safe, effective care. OSD serves as a tool to assist
providers and subject matter experts in their clinical practice as they treat Veterans
experiencing chronic pain.
d. Similar concerns regarding overmedication and medication management have
been raised about DODs approach to the treatment of wounded warriors. Based on
the success VA has reported from the OSI conducted at eight sites in Minnesota,
are there lessons learned that could be shared with DOD?
Response. The Minneapolis VA OSI team has shared information about the methods and results with the Department of Defense (DOD) and the private sector. At
the American Academy of Pain Medicines annual meeting on March 7, 2014, Peter
Marshall, M.D., from the Minneapolis VA Health Care System presented a summary of methods and outcomes of the Minneapolis VA OSI to the Veterans Health
Administration (VHA) and DOD pain management leaders. Dr. Marshall also communicated with Christopher Spevak, M.D., pain specialist at Walter Reed National
Military Medical Center, and shared Minneapolis OSI data and other OSI and Minneapolis Pain Center program documents. The Minneapolis VA OSI team is also
available to provide other information and support if requested by DOD. In addition,
the Minneapolis OSI team is submitting a manuscript for publication in Pain Medicine describing OSI methods and outcomes.
e. What efforts are VA undertaking to make sure DOD is aware of VAs work on
this issue as DOD continues to address similar issues among its wounded warrior
population?
Response. VHA regularly presents progress on its various pain management initiatives to the DOD/VA Health Executive Committees (HEC) Pain Management
Work Group (PMWG), where discussion and planning of joint programs in pain
management take place. PMWG discusses issues related to opioid safety including
standardizing urine drug testing and the implementation and use of the DOD/VA
Chronic Opioid Therapy Guidelines. OSI and its pilot results will be presented to
the HEC PMWG for a discussion of its general implementation in VHA and DOD
more widely. It is anticipated that the pilot results will be presented at a full HEC
meeting later in 2014.
Question 9. Provide a detailed description of how VA intends to ensure the projected amount of money is collected through the Medical Care Collections Fund in
FY15.
a. Specifically, what plans does VA have for increasing the collection of accurate
third-party reimbursement information from both existing and new patients?
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Response. To ensure that VA collects the amount projected in fiscal year (FY)
2015, VA has deployed seven industry best practice Consolidated Patient Account
Centers (CPAC) to manage back office collection activities such as billing and accounts receivable follow up. CPACs were deployed in FY 2012, which is 1 year earlier than mandated under Public Law 110387. CPACs focus on standardized processes and intensive employee training has proven to be successful as evidenced by
both achievement of expected collection results and performance in key industry
performance metrics.
VA also has focused on identifying opportunities to improve front-end revenue
cycle processes related to collection of accurate insurance information. Toward that
end, VHA is deploying an Integrated Resources Center (IRC) that provides resources
to staff to increase their knowledge of approved methods for obtaining and recording
demographic and health insurance information. The IRC library will include links
to intake training modules; current policies, procedures and directives; scripts; a
best practice registry; intake performance tracking; and online training videos made
in cooperation with VHAs Employee Education Service.
b. How does VA plan to make up for any shortfall if the budget projection of $3
billion is not met?
Response. VA does not expect to have a shortfall in the Medical Care Collections
Fund in 2015. All funding requirements and sources of funds are reviewed periodically throughout the fiscal year. As of May 2014 our aged 3rd Party receivables,
which are defined as payments from insurers that havent been received by 90 days
after billing, amounted to $114 million.
Question 10. In its response to my post-hearing questions regarding the FY 2014
budget request, VA noted it had developed and implemented staffing guidance for
general outpatient mental health programs.
a. Has VA developed a staffing model for determining the target number of mental health staff for a whole facility? If no, please explain any progress toward development of a staffing model and when VAs expects to complete development and implementation.
Response. VAs guidance for outpatient staffing levels is developed in the context
of: (1) data on Veteran access to timely, full-spectrum mental health services at appropriate intensity, and (2) information on the local facility organization (e.g., number and location of Community-Based Outpatient Clinics (CBOC)), the geographical
area the facility serves, and the availability of inpatient, residential, telehealth, and
regional specialty mental health services. It is expected that appropriate staffing
levels will vary somewhat based on: local Veteran needs; whether the patient population resides in a rural area; facility use of contracted or telehealth-based services,
collaborative service delivery with local residential treatment programs, and other
factors. As there are strong relationships between mental health staffing levels and
Veteran access to mental health services, indications of poor access are considered
a trigger for review of adequacy of clinical staffing and planning for remediation of
access concerns.
VA has been developing staffing guidance based on patient demand to assist facilities in ensuring consistent staffing for mental health. For sites with hiring/staffing challenges, VA is expanding the use of contracts and the use of telemental
health. Methods to estimate future staff needs based on mental health workload
projections have been drafted and are being reviewed and refined. This modeling
will provide targets for all mental health staffing needs at a facility. VHA expects
to conduct internal validation of this modeling over the next 2 fiscal years to determine whether facility adherence to the model is associated with maintenance of Veteran access to mental health services as the mental health patient population
grows, and adjust within that time as necessary.
b. In the absence of such a model, describe the methodology VA uses to accurately
budget for mental health care.
Response. Please see the response to Question 10a.
Question 11. What percentage of dental care is provided at VA facilities and what
percentage is provided through non-VA care?
Response. For FY 2013, 86 percent of dental workload (measured in Relative
Value Units) was completed on-site at VA facilities and 14 percent was completed
through non-VA Care. There were 462,254 total patients, 442,688 received care
within VA on-site and 54,929 received care in the private sector. Some patients received care in both venues.
Question 12. Has VA experienced difficulties in recruiting qualified individuals to
fill open dental vacancies? If so, explain what VA has done to address this issue.
Response. VA receives sufficient applications to recruit qualified individuals to fill
open dentist occupational vacancies with the exception of certain scarce specialties
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such as oral surgeons. As of July 15, 2014, there are 20 dentist vacancies and 2 dental hygienist vacancies listed on the USAJobs Web site. The average speed of hire
(SOH) timeframe to hire these dental occupations is 41.99 days, which is less than
VAs SOH goal of 60 days. This data accounts for all hires of the previously mentioned occupations from October 1, 2013, through February 28, 2014.
Additionally, the following initiatives have been launched to enhance the recruitment of dental hygenists and lab technicians:
Hygienists: The qualification standard for dental hygienists is being updated to
create a career ladder potential for advancement for dental hygienists in VA that
mirrors the private sector.
Laboratory Technicians: The Central Dental Laboratories maintain a skills development program to advance technicians skills and abilities internally.
Outsourced laboratory services are also used to fill the gap.
Question 13. In the medical patient caseload portion of the FY 2015 budget request, VA estimates between FY 2014 and FY 2015, an additional 112,519 Priority
Groups 16 veterans will access VA health care. Yet, it estimates a decrease of
2,021 veterans in Priority Groups 7 and 8 for the same period of time and a further
decrease of 9,249 veterans from 2015 to 2016. Given the Affordable Care Act (ACA)
requires Americans to obtain health care coverage before March 31, 2014, many uninsured veterans will turn to VA for their health care needs. VA estimates it will
see an increase of 63,000 veterans in 2015 as a result of ACA implementation.
a. Why does VA estimate a decrease in Priority Groups 7 and 8 veterans in the
FY 2015 budget?
Response. VAs FY 2015 Medical Care budget request does not project a decrease
in Priority Group 7 and 8 enrolled Veterans, VA projects an increase of 27,987 enrollees (see page 32 of the second volume of the FY 2015 Budget). The 2,021 Veteran
decline reflects the projected decrease in the number of Priority Group 7 and 8 patients. The VA Enrollee Health Care Projection Model (EHCPM) projects enrollee
health care services over a 20-year planning period. For each year, the EHCPM
projects the number of Veterans expected to be enrolled, their priority, age, gender,
special conflict status, and geographic location. The patient projections model estimates the probability of enrollees becoming patients each fiscal year. Patients are
projected as a function of enrollee type, priority, age, gender, special conflict status,
and assumed morbidity and reliance levels. While projections for Priority Group 7
and 8 enrollees, as reflected in the FY 2015 budget submission, suggest a slight increase in enrollment for this population, since many of these enrollees have some
other form of public/private health insurance coverage, they tend to be less reliant
upon VA for care, and therefore do not generate a corresponding increase in patients, as noted by the projected decline of 2,021 Veterans in the chart on page 7
of the second volume of the FY 2015 Budget. Historical data also shows a decline
in Priority Group 7 and 8 patients.
b. Provide the following information regarding priority groups:
i. The number of such veterans moving from Priority Groups 7 and 8 to Priority Groups 16 between FY 2014 and FY 2015; and
Response. The net number of enrollees that are projected to move from Priorities 7 and 8 into Priorities 16 between FY 2014 and FY 2015 is 15,566.
(**Note: This is the net number of enrollees moving into Priorities 16. This
means that enrollees moving from Priority Groups 78 into Priority Groups 1
6 are offset by enrollees moving from Priority Groups 16 into Priority Groups
78. There are significant movements in both directions, and the net movement
is close to zero. Movements from Priorities 48 into Priorities 13 are estimated
to be 132,325 during the same time period (FY 2014 to FY 2015)).
ii. The number of veterans currently enrolled in the VA health care system
that VA expects will become ineligible, in 2015 and 2016, for VA health care
due to its geographic means test.
Response. Veterans currently enrolled do not become ineligible based on a geographic means test, if they are already enrolled.
Question 14. In the performance measure section of the Presidents FY 2015 budget request, VA reports an increase of 38 percent, from 2012 to 2013, of targeted
OEF/OIF veterans with a primary diagnosis of PTSD who receive a minimum of
eight psychotherapy sessions within a 14-week period. Provide the Committee with
the criteria utilized in FY 2012 and FY 2013 individually to identify these targeted
OEF/OIF veterans.
Response. VA did not report a 38-percent increase in the percentage of Operation
Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND)
Veterans receiving 8 psychotherapy visits in 14 weeks. We believe that this number
may have been incorrectly surmised as it looks to be the difference between the
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measure in existence in FY 2012 and the measure in existence for FY 2013. However, these two metrics are not comparable. Below is a description of each measure,
and a summary of the changes in utilization of psychotherapy across the 2 years.
In FY 2012, the measure (OEF 4) was a percentage defined by the following numerator and denominator. The denominator (see FY 2012 Presidential Budget Submission, Volume II, page 1G23) included Veterans who were deployed in OEF/OIF/
OND and had two primary diagnoses of Post Traumatic Stress Disorder (PTSD) in
two outpatient encounters that occur within 90 days of each other. Patients are entered into the denominator once they received a second encounter with a primary
diagnosis of PTSD. A number of visit types such as telephone contacts and vocational services were excluded when looking for qualifying encounters. In addition,
any Veteran who had already received at least 8 visits in 14 weeks in the previous
5 years was excluded from the denominator. The numerator consisted of Veterans
who are included in the denominator and have encounters with PTSD as the primary or secondary diagnosis for 8 psychotherapy sessions within a 14-week time period after the qualifying encounters. The measure in FY 2012 was reported as a
straight percentage. At the end of the fiscal year, there were cumulatively 8,155
Veterans in the numerator and 56,103 Veterans in the denominator, for a percentage of 14.54 percent.
In FY 2013, the measure reported (OEF 41) was changed (see FY 2013 Presidential Budget Submission Volume II, page 1H6). Conceptually, the numerator and
denominator remain the same as OEF 4, although some additional exclusions were
placed on the denominator such as an expanded set of clinic types that would not
count toward qualifying encounters and the removal of Veterans who passed away
after being qualified for the denominator. Most importantly, however, the measure
was redefined to reflect the fact that not all Veterans will want or be ready for this
particular type of treatment. Previous VA research had indicated that about 30 percent of Veterans offered these interventions will actually begin the therapies. Therefore, the new measure is calculated as the numerator divided by the denominator
and then divided by 30 percent. In FY 2013, the numerator was 8,530, the denominator was 53,297. The ratio to be used to compare to FY 2012 was 16.0 percent,
and the final measure (16 percent/30 percent) is 53.33 percent of all OEF/OIF/OND
Veterans who could benefit from the treatment and who will want and be ready for
the treatment.
It appears that whomever reported the 38-percent change mistakenly subtracted
the FY 2012 number from the FY 2013 number (a difference of 38.79), not being
aware that the measures were not comparable. Since the numerator and denominator are roughly comparable, we can say that there was a 1.5 percent increase in
the proportion of OEF/OIF/OND Veterans receiving 8 visits in 14 weeks.
Question 15. What is the population size of the targeted population? Has the population size changed since 2012?
Response. The targeted population is Veterans defined by the denominators described in the response to question 14. In FY 2012, it was 56,103 Veterans, while
in FY 2013 it was 53,297. This number is separate from the number of OEF/OIF/
OND Veterans with PTSD served by VA.
Question 16. In the performance measure section of the Presidents FY 2015 budget request, VA reports that 73 percent of veterans answered yes to the shared
decisionmaking question in the Inpatient Surveys of the Health Experience of Patients (SHEP). VA also notes this question will be deleted after Fiscal Year 2014
and replaced with alternative satisfaction measures.
a. Provide the Committee with the alternative satisfaction measures that will
be used.
Response. The Self-Management Support measure, found in the Patient Centered
Medical Home (PCMH) Consumer Assessment of Health Providers and Systems
(CAHPS) that forms the basis of VHAs Outpatient SHEP will replace the Inpatient
Shared Decision Making measure. This new measure has undergone extensive testing for validity and expands the concept of shared decisionmaking into VAs PACTs,
which forms the foundation of our Veteran-centered health care efforts. This new
measure is calculated as the average of the weighted percentage of patients who responded Yes to questions 35 and 36, in the last 12 months, did anyone in this
providers office talk with you about specific goals for your health, and in the last
12 months, did anyone in this providers office ask you if there are things that make
it hard for you to take care of your health, respectively, in the SHEP survey.
b. What measures or initiatives is VA currently implementing to increase the percentage of veterans involved in making decisions regarding their health care, including mental health?
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Response. VHA has developed and piloted the Personal Health Inventory as a tool
for Veterans and teams. This tool allows Veterans and providers to discuss life goals
and preferences in a personalized plan of care. A number of VHA facilities have deployed an interactive bedside system, which allows the Veteran more direct access
to their care team. These systems allow the Veteran to provide input on their care
while at the facility and also provide an opportunity for staff to respond timely to
issues identified during the stay. Additionally, VHA has developed and deployed
staff training classes in order to educate staff about involving Veterans in making
decisions regarding their health care.
Question 17. What measures and initiatives has VA utilized to achieve a decrease
in the amount it spends per patient for OEF/OIF/OND veterans of $212 per veteran,
from 2012 to 2013, while increasing the spending by $45 per patient for all VA patients, during the same time period?
Response. The decrease in cost per patient of $212 per Veteran from 2012 to 2013
was an error and the result of a miscalculation in overhead costs. The correct 2012
actual is reflected in the table below. On average, the OEF/OIF/OND Veterans populations medical care is increasing in complexity which translates into an increased
cost for medical treatment. OEF/OIF/OND is a subset of the total obligations per
unique patient. This error had no impact on the total budget request, as the correct
actual data was included in the estimates generated by the VA EHCPM.
Description
OEF/OIF/OND
Obligations ($000) ...............................................................
Unique Patients ....................................................................
Cost per Patient ...................................................................
Obligations per Unique Patient
Obligations ($000) ...............................................................
Unique Patients ....................................................................
Cost per Patient ...................................................................
2012 Actual
2013 Actual
Difference
$2,745,534
544,088
$5,046
$3,208,682
616,487
$5,205
$463,143
72,399
$159
$53,868,410
6,333,091
$8,506
$55,453,211
6,484,664
$8,551
$1,584,801
151,573
$45
Question 18. The FY 2015 budget request states that in 2013, the HUD-VASH
program funded 562 additional positions in various disciplines, including peer support positions, employment specialists, psychiatrists, nurses, and housing specialists.
a. How many additional positions in each discipline will be funded with the $46.8
million increase for FY15?
Response. VA medical centers (VAMCs) receive funding for additional positions to
support the HUD-VASH Program after each VAMCs specific allocation of new
vouchers is determined. Until the FY 2015 specific allocations occur, VA is only able
to estimate the total number of additional FTE expected to be funded based on previous years allocations; accordingly an estimated 500 additional FTE will be funded
in FY 2015.
b. Describe the service impact of the $138.5 million anticipated reduction in the
FY 2016 advanced appropriation request for this program.
Response. The FY 2015 request of $321 million provides the funding level needed
to sustain current service levels in the Department of Housing and Urban Development-VA Supportive Housing (HUD-VASH) vouchers as well as support 20,000 additional HUD-VASH vouchers issued in FY 2014 and FY 2015. A decrement of $200
million in FY 2015 (as reflected in the FY 2015 Advanced Appropriation) or $138.5
million in the FY 2016 Advanced Appropriation will require significant reductions
in the level of case management support that can be provided to Veterans. The final
2016 funding level will be determined during the 2016 budget process when updated
data and metrics are available; however, if these reductions occur in either year, the
impact on HUD-VASH operations and on the Veterans served by the program will
be quite significant. Also, service impacts could include significant reductions in
level of case mangagment support. Caseloads will increase considerably and process
times for moving Veterans from the streets to housing will also increase significantly. VHA also anticipates an increase in negative discharges from the program,
including evictions and unit abandonment, and we can expect additional negative
outcomes due to the reduction in frequency and intensity of case management support.
Question 19. The FY 2015 budget submission details that funding for contract residential services (CRS) available through the health care for homeless veterans program has recently been prioritized to ensure that every VAMC has the capacity to
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offer bridge housing, services that are targeted to and prioritized for homeless Veterans who are transitioning from literal street homelessness.
a. As of March 12, 2014, which VAMCs currently lack the capacity to offer these
services?
Response. VAMCs may request funding from VA Central Office to establish
Health Care for Homeless Veterans (HCHV) Contract Residential Services (CRS)
contracts. It is important to note that VAMCs only request funding for HCHV CRS
when the need for these services is not being met by local community resources or
by neighboring VA facilities. VA uses HCHV CRS contracts to fill gaps in local continuums of homeless services.
b. Describe the Departments efforts to ensure that bridge housing is available to
veterans, without regard to their gender in each location.
Response. Each local VAMC that receives VA Central Office funding to establish
new or expand existing HCHV CRS contracts is expected to include explicit contract
language to ensure that housing services be available to both male and female
homeless Veterans. As of March 2014, female Veterans make up 5 percent of the
total population of homeless Veterans admitted to HCHV CRS programs, representing an increase from 3 percent in FY 2012.
Question 20. The Presidents budget request indicates a transition in the HVSEP
program, with the provision of funding to hire 160 community employment coordinators.
a. Are these coordinators intended to supplement, or to replace, the over 400
homeless or formerly homeless veterans currently staffing this program as Vocational Rehabilitation Specialists?
Response. The Homeless Veteran Supported Employment Program (HVSEP) hired
formerly homeless or at-risk-of-homelessness Veterans as Vocational Rehabilitation
Specialists on term positions for a 4-year period. Funding for these positions will
end on September 30, 2014.
As a result of the HVSEP Initiative, 70 percent of HVSEP Vocational Rehabilitation Specialists successfully transitioned into alternative permanent employment,
358 within VA and 36 with other Federal agencies or in the community.
In order to continue to provide a full-range of employment services, the new Community Employment Coordinators will augment and coordinate the competitive employment services that are currently available for homeless and chronically homeless Veterans both at VAMCs and in the community. The Community Employment
Coordinators will oversee the provision of training and guidance to all VA homeless
programs and staff on resources that result in competitive employment outcomes for
homeless Veterans. The Community Employment Coordinators will also provide direct assistance in connecting Veterans to the most appropriate and least restrictive
VA and community-based employment services leading to competitive employment
with appropriate supports.
b. How will these coordinators interact with other employment programs this population may be eligible for, such as VBAs Vocational Rehabilitation program or the
Department of Labors Homeless Veterans Reintegration Program Grantees?
Response. Partnerships with Federal, state, and community agencies are critical
in addressing unemployment among homeless Veterans. The Community Employment Coordinators will serve as liaisons and referral sources to VA and non-VA programs that provide community-based employment opportunities and support services to homeless and chronically homeless Veterans including but not limited to:
Compensated Work Therapy Programs; HCHV and HUD-VASH Employment Specialists; Supportive Services for Veteran Families (SSVF) and Grant and Per Diem
(GPD) grantees that target employment; Veterans Benefits Administration/Vocational Rehabilitation and Employment; Department of Labor grantees such as the
Homeless Veteran Reintegration Program; and, state, local, community, and faithbased organizations.
CONSTRUCTION AND LONG RANGE CAPITAL PLAN
Question 21. Provide a list of priority weights for the major criteria and sub criteria used to inform the FY 2015 Strategic Capital Investment Plan decision plan.
Response. The diagram below shows the major criteria and sub-criteria priority
weights that were used to inform the fiscal year (FY) 2015 Strategic Capital Investment Planning (SCIP) process.
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Question 22. The FY 2015 budget request includes a number of funding requests
to renovate and realign VA Regional Offices. Of these, which are due to decreased
space requirements as a result of the transition to a paperless claims processing system?
Response. The RO renovation and realignment projects were approved for the following sites in FY 2015: Boston, Detroit, and New York. These offices will be renovated to meet current size and safety standards and realigned to optimize efficient
space utilization, taking into account that many paper claims received are being
converted into an electronic format. Renovation and realignment projects typically
take 2 to 3 years to complete. The FY 2015 budget request is dedicated to developing the space design and determining the resulting space savings. Funding for
construction and realignment of the space would then be included in the FY 2016
and 2017 budget requests.
a. Provide a list of any location where VBA has leased space for the sole purpose
of storing paper claims files. For each, also provide an estimated date the lease will
no longer be needed and the estimated annual savings that would result from not
leasing this space.
Response. The chart below shows the locations where separate file storage is
leased through General Services Administration, contracted through Iron Mountain
(or another storage vendor), or located on a Veterans Health Administration campus. The ROs listed on the spreadsheet have a project submission for renovation
and realignment over the next 10 years in VBAs long-range Strategic Capital Investment Plan submission; however, projects beyond FY 2015 are notional and not
yet funded. VA will work to find solutions for removal of files from these separately
leased facilities ahead of the renovation schedule of their respective RO, should
funding become available.
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Question 23. The FY 2015 budget submission details the departments efforts to
conduct onsite surveys of waste streams at 140 facilities in order to assist meeting
waste diversion goals and save disposal costs.
a. Share how these 140 facilities were chosen.
Response. Given the travel time and cost associated with reaching several of our
facilities, VHA included 140 facilities in the review process. These 140 facilities were
chosen because they encompass a cross-section of every VISN and complexity level
of facility in the system. This allows the lessons learned from these reviews to be
shared with those facilities not included in the review.
b. Share the results of these surveys.
Response. VHA continues to work with the vendor to resolve several issues with
the draft of the waste and recycling assessment summary report. Until these issues
are addressed, VA will not accept the report as final. Once the report has been accepted, VA will provide the Committee with a complete copy of the individual reports requested.
c. Share any outcomes that resulted from an analysis of this data.
Response. Based on the initial review of the survey report data, there are areas
of opportunity to increase recycling activities throughout VHA, particularly in the
operating rooms, management of food waste, and composting. The survey also reinforced the need and benefits of the new web-based waste and recycling system,
which has been implemented throughout VHA for tracking diversion rates in accordance with Executive Order (EO) 13514, Federal Leadership in Environmental, Energy, and Economic Performance. EO 13514 challenges government agencies with diverting up to 50 percent of municipal solid non-hazardous waste from landfills by
the end of FY 2015. This is generally accomplished through recycling, reuse and
composting programs.
54
Question 24. Describe planned improvements in FY 2015 to the functionality of
VAs national utility metering data collection and analysis system.
Response. In FY 2015, VA will expand the analysis and reporting capabilities of
its metering data collection and analysis system. These new functionalities will
build on the progress made in FY 2014 that implemented services for integrating
electric and non-electric (e.g., gas, water, steam, chilled water) meter data into the
system. As metering data is added to the system, these new capabilities will allow
energy managers to access data more easily and in different ways. These expanded
capabilities will accommodate data from all future as well as existing electric and
non-electric meters. VA also plans to conduct training for personnel on the use of
the database systems analyses and reporting capabilities.
INFORMATION TECHNOLOGY PROGRAMS
Question 25. The FY 2015 budget request indicates that a portion of the
cybersecurity funding requested will be used to maintain information protection directives and handbooks so VA is compliant with all applicable Federal requirements
and standards such as FISMA, HIPAA, the E-government Act, FIA, Privacy Act,
and other requirements. Provide a list of each directive and handbook that is not
in compliance, as of March 12, 2014.
Response. All Department of Veterans Affairs (VA) security-related directives and
handbooks are in compliance with Federal regulations and guidelines. VA has drafted a new version of VA Handbook 6500 that includes all the changes from National
Institutes of Standards and Technology (NIST) 80053, Revision 4, which was published in May 2013. Federal agencies have one year from the date of publication to
come into compliance with NIST guidelines. VA expects to publish this version of
VA Handbook 6500 by the end of fiscal year 2014. In the interim, while the VA
Handbook 6500 is going through VAs internal concurrence process, VA is implementing the draft guidelines to secure VA information technology systems, and will
make any adjustments necessary that are needed to reflect the final guidelines.
Question 26. How many additional FTE will be required in FY 2015 to fully staff
the reorganized Network Operations Center and Security Operations Center? Of
these, how many will be VA employees and how many will be contract employees?
Response. The Department of Veterans Affairs takes the protection of our Veterans and employees data seriously. VA has in place strong, multi-layered defense
to combat evolving cyber security threats. Defenses include monitoring outside our
network by external partners; active scanning of Web applications and source code;
and protection of servers, workstations, networks, and gateways, among other security efforts.
The Department will be reviewing all details of the proposed reorganization of the
VA Network Security Operations Center to ensure that the continued high level of
service is maintained should a separate Network Operations Center (NOC) and a
separate Security Operations Center (SOC) be put in place. The current organizational structure includes network and security staffs at two different locations with
varying skill sets and the intent of this re-alignment is to improve efficiencies in
responding to network and security operational requirements. The ongoing review
will include the development and update of a strategy and concept of operations
(CONOPS) for the NOC and the SOC, which will be completed in FY 2015. The results of the work to develop the strategy and CONOPS for the SOC and the NOC
will re-validate the government FTE and contractor current staffing estimates and
requirements and help guide the reorganization efforts. VA will develop a phased
approach to establish a recruitment and retention strategy to support the proposed
number of personnel for each organization, to ensure that we maintain the highly
technical skills and expertise required to support security and network operations.
Question 27. Of the additional funding requested for VBMS in FY 2015, how much
does VA anticipate dedicating to making workload management improvements to
improve the ability of veterans service organizations and other accredited representatives to assist veterans in managing their claim?
Response. Veterans Service Organizations (VSO) currently have the ability to perform a number of functions in Veterans Benefits Management System (VBMS), including:
Conducting searches
Viewing assigned items in the VSO work queue
Viewing the Veteran eFolder and annotations
Viewing the Veteran Profile and service information
Viewing claim contentions and claim detail
Viewing rated issues and review ratings decisions
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VBMS is being developed and implemented in a phased approach consisting of incremental software releases. As the system evolves, new functionality is delivered
to the field and builds upon the foundational architecture available in the latest system release. The scope of each release is prioritized based on business needs as determined by leadership direction, resources, business-line inputs, field enhancement
requests, and defect reports. Improvements to VBMS workload management is one
of the main goals for software releases in fiscal year 2015.
Department of Veterans Affairs (VA) is currently determining the specific capabilities to be delivered in each release. Once the specific capabilities are finalized,
funding can be allocated. Because workload management capabilities for VSOs are
not fully defined or scoped, VA is not yet able to provide an estimate of resources
(personnel or money) required in 2015. VBMS generally deploys a new software release at the end of each fiscal quarter, and the scope of each release is finalized
approximately 4 to 6 months before the release date. VA would be happy to brief
the Committee on this issue as soon as the capabilities for VSOs in VBMS become
fully defined and scoped.
Question 28. The FY 2015 budget request includes $20 million to rapidly replace
obsolete telephony equipment and $92 million to provide Voice as a Service solutions
in order move away from private branch exchanges and into a unified communication strategy. Are these amounts sufficient for an enterprise-wide replacement? If
not, provide a deployment plan for this initiative, including a list of locations where
telephony equipment will be switched out in FY15.
Response. The Voice as a Service initiative will replace over 1,300 voice systems
across the Department of Veterans Affairs (VA) enterprise, including the voice systems at VA medical centers and Regional Offices, over a period of approximately 10
years. The number of systems migrated in a given year will be determined primarily
by funding availability.
The Presidents 2015 budget request of $92 million includes the replacement of
the first wave of over 200 voice systems and many mandatory dependencies such
as detailed site surveys, local area network upgrades, wide area network augmentation, and recurring operation and maintenance costs.
Please see the attached sheet showing the list of facilities planned for fiscal year
(FY) 2015 migration upon completion of the current pilot project. Procurements supporting site preparation for the locations listed in the attached sheet are funded and
planned for execution in FY 2014.
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62
Question 29. Provide a list of the additional 36 VA Health Information Exchange

partners planned for 2014 and the partners VA plans to add in 2015.
Response.
City
State
Status
HealtheConnections NY .....................................................
Hawaii Pacific Health ........................................................
University of California Davis ...........................................
Allina Health ......................................................................
Mt Sinai Medical Center Miami ........................................
Sentara Health care ..........................................................
Dignity Health ....................................................................
East Tennessee HIN ...........................................................
HIETexas ............................................................................
Lancaster General Health ..................................................
Maine HealthInfoNet ..........................................................
Medical University of South Carolina ...............................
MetroHealth System ...........................................................
Michigan HIN .....................................................................
Oregon Community Health ................................................
Redwood MedNet HIE ........................................................
Yale New Haven Health System ........................................
Alaska eHealth Network ....................................................
Cleveland Clinic ................................................................
CVS MinuteClinic ...............................................................
Geisinger Health Systems .................................................
Georgia HIN .......................................................................
Greater Dayton Area Health ..............................................
HealtHIE Nevada ................................................................
Kansas HIN (KHIN) ............................................................
Social Security Administration ..........................................
University of Pittsburgh Medical Center (UPMC) ..............
Wisconsin Statewide HIN (WISHIN) ...................................
Alabama One Health Record .............................................
Bronx RHIO ........................................................................
Carle Foundation Hospital .................................................
Central Florida RHIO .........................................................
Syracuse
Honolulu
Sacramento
Minneapolis
Miami Beach
Norfolk
San Francisco
Knoxville
Austin
Lancaster
Portland
Charleston
Cleveland
East Lansing
Portland
Ukiah
New Haven
Anchorage
Cleveland
Woonsocket
Danville
Atlanta
Dayton
Las Vegas
Topeka
Baltimore
Pittsburgh
Madison
Montgomery
Bronx
Urbana
Orlando
NY
HI
CA
MN
FL
VA
CA
TN
TX
PA
ME
SC
OH
MI
OR
CA
CT
AK
OH
RI
PA
GA
OH
NV
KS
MD
PA
WI
AL
NY
IL
FL
In Production
In Production
In Production
On-Boarding
On-Boarding
On-Boarding
On-Boarding
On-Boarding
On-Boarding
On-Boarding
On-Boarding
On-Boarding
On-Boarding
On-Boarding
On-Boarding
On-Boarding
On-Boarding
Potential
Potential
Potential
Potential
Potential
Potential
Potential
Potential
Potential
Potential
Potential
Potential
Potential
Potential
Potential
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FY 2014/
2015
FY
FY
FY
FY
FY
FY
FY
FY
FY
FY
FY
FY
FY
FY
FY
FY
FY
FY
FY
FY
FY
FY
FY
FY
FY
FY
FY
FY
FY
FY
FY
FY
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2015
2015
2015
2015
2015
2015
2015
2015
2015
2015
2015
2015
2015
2015
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Partner Name
63
Partner Name
City
State
Status
ConnectVirginia .................................................................
EHR Doctors .......................................................................
Hawaii HIE .........................................................................
Health Access San Antonio ...............................................
Glen Allen
Pompano Beach
Honolulu
San Antonio
VA
FL
HI
TX
Potential
Potential
Potential
Potential
RESPONSE
TO
FY 2014/
2015
FY
FY
FY
FY
POSTHEARING QUESTIONS SUBMITTED BY HON. RICHARD BURR

2015
2015
2015
2015
TO
GENERAL
Question 30. At the end of fiscal year 2011, the Department of Veterans Affairs
(VA) reported $1.2 billion in outstanding delinquent debt owed to VA, of which $732
million was created in connection with VA benefit payments. In response to questions about VAs fiscal year 2014 budget request, VA indicated that, at the end of
fiscal year 2012, there was $3.7 billion in outstanding delinquent debt owed to VA,
of which $1.6 billion was created in connection with VA benefit payments. VA also
indicated that, during fiscal year 2012, VA wrote off or waived $201 million of debts
to VA.
A. Please explain what factors led to an increase from $1.2 billion to $3.7 billion
in outstanding delinquent debt between the end of fiscal year 2011 and 2012.
Response. According to the Treasury Report on Receivables (TROR), the $3.7 billion amount referenced in this question relates to total Department of Veterans Affairs debt outstanding at the end of fiscal year (FY) 2012. This amount includes debt
that is delinquent (greater than 30 days); debt that is less than 30 days old; and
debt that is part of an established loan or repayment agreement paid in installments. Delinquent debt at the end of FY 2011 and FY 2012 remained stable at approximately $1.2 billion.
B. Please explain what factors led to an increase from $732 million to $1.6 billion
in outstanding benefit debt between the end of fiscal year 2011 and 2012.
Response. Department of Veterans Affairs (VA) Treasury Report on Receivables
(TROR) records indicate that outstanding benefit debt decreased slightly from $2.4
billion to $2.2 billion between the end of fiscal years (FY) 2011 and 2012. VA TROR
records indicate that outstanding delinquent benefit debt decreased slightly from
$770 million to $730 million between the end of FYs 2011 and 2012.
C. What was the total amount of outstanding delinquent debt at the end of fiscal
year 2013?
Response. $1,169,280,757.
D. What portion of that amount was debt created in connection with VA benefit
payments?
Response. $693,453,840
E. What portion of the delinquent debt was created in connection with the Veterans Health Administration (VHA)?
Response. $474,551,351
F. What is the total value of debts for which VA waived recoupment during fiscal
year 2013 and what is the total value of debts that were written off during fiscal
year 2013?
Response. Fiscal year 2013 Waived and Written Off Debt: $339,324,218
G. During fiscal year 2014, how much new debt does VA project will be established?
Response. Based on current trends, Department of Veterans Affairs estimates
that it will establish $823,300 new Veterans Benefits Administration debts and
$379,597 new Veterans Health Administration debts in fiscal year 2014.
H. During fiscal year 2015, how much new debt does VA project will be established?
Response. Based on current trends, Department of Veterans Affairs estimates
that it will establish $880,900 new Veterans Benefits Administration debts and
$386,435 new Veterans Health Administration debts in fiscal year 2015.
Question 31. In response to questions regarding VAs fiscal year 2014 budget request, VA indicated that approximately $285 million in mandatory funding would
be used to pay for non-direct benefits, including the salaries for 98 full-time equivalent (FTE) employees.
A. For fiscal year 2015, please identify how much in mandatory funding will be
spent on non-direct benefits and how those funds would be spent.
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Response. In FY 2015, VBA expects to spend $296.7 million in mandatory funding
on non-direct benefits. The $296.7 million in mandatory funding used to pay for
non-direct benefits includes funding for: Equal Access to Justice Act payments, Medical Examinations payments, and Income Verification Matching (38 United States
Code (U.S.C.) section 5317) from the C&P account. This also includes: Reporting
Fees, State Approving Agencies (SAA), reimbursements to the GOE account as authorized under Public Laws (P.L.) 101237 and 105368, and reimbursement to the
Office of Information and Technology (OIT) account as authorized under Public Law
106419, 108454, and 11256 from the Readjustment Benefits (RB) account.
Additionally, under section 3674 of title 38 U.S.C., VBA is authorized to reimburse SAAs up to $19 million from the RB account. This funding is authorized for
the reasonable and necessary personal services, travel, and administrative expenses
incurred by the employees of SAAs in carrying out contracts for agreements entered
into with VBA for the purposes of ascertaining the qualifications of educational institutions for furnishing courses of education to eligible persons or Veterans.
VBA is also authorized under section 3684 of title 38 U.S.C., to pay any educational institution, or the sponsor of a program of apprenticeship furnishing education or training under Chapter 31, 33, 34, 35, or 36, a reporting fee which will
be in lieu of any other compensation or reimbursement for reports or certifications
which such educational institution or joint apprenticeship training committee is required to submit to the Secretary by law or regulation.
Below is a detailed breakdown of the requested funding:
C&P ($000s)
Medical Exams ...........................................................................
Equal Access to Justice Act .......................................................
Income Verification Matching ....................................................
$237,587
$10,554
$15,430
C&P Total ..........................................................................
$263,571
RB ($000s)
SAAs ............................................................................................
Reporting Fees ............................................................................
Reimbursement to GOE (Outreach) ............................................
$19,000
$13,574
$591
RB Total ......................................................................................
$33,165
Total ...................................................................................
$296,736
B. For fiscal year 2015, are mandatory funds expected to be used to pay the salary
of any VA employees? If so, please specify the amount(s) and purpose(s).
Response. Section 5317 of title 38 U.S.C., directs VBA to pay the expenses of administering certain income verification matching activities with funds from the
mandatory C&P appropriation. Accordingly, the C&P appropriation reimburses the
GOE account and OIT account for administrative costs associated with verification
of eligibility for the C&P programs through income verification matching. The FY
2015 reimbursement to the GOE account is estimated to be $14.7 million to support
165 FTE. In FY 2015, the reimbursement to the OIT account is estimated to be
$112,200 in support of one FTE.
P.L. 104275 directs VA to make payments for contracts for the pilot program for
disability examinations from the C&P appropriation. Accordingly, the C&P appropriation has reimbursed the GOE account for the purposes of this pilot program.
The FY 2015 reimbursement amount is estimated to be $2.7 million to support 25
FTE.
Question 32. This budget would cut VA central office (VACO) funding by $4 million or 1.2 percent; however, the offices that comprise VACO would realize an increase of 38 FTE if this budget were adopted. During last years budget rollout on
April 10, 2013, VA responded to a question about the contradiction of an increase
in FTE and a funding decrease by stating that the additional staff is paid for out
of the Supply Fund and Franchise Fund. Additionally, throughout the budget request for the General Administration account, many offices within VACO indicate
budget allocations and staffing under the heading reimbursement.
A. Of the 2,832 staff requested in the fiscal year 2015 budget request, how many
are funded through the Supply Fund and Franchise Fund? Please breakout this
number by individual VACO offices (for example, Office of the Secretary, Office of
General Counsel, Office of Policy and Planning, etc.).
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Response. The budget reduction of $4 million in the General Administration account is a result of the transfer of rent funds to the Board of Veterans Appeals
new appropriation account and is unrelated to pay of personnel or full-time equivalent employees (FTE). In fiscal year (FY) 2015, 74 FTE in the General Administration account (76 FTE in FY 2014) are supported through reimbursements from the
Supply Fund (60 within the Office of General Counsel, 7 within the Office of Acquisition, Logistics and Construction, and 7 within the Office of Management). No General Administration FTEs are supported by reimbursements from the Franchise
Fund.
B. For reimbursable FTE, please provide the Committee with information regarding the office, department, or agency that is being reimbursed, a description of the
program or service for which they are being reimbursed, and the number of staff
associated with the reimbursement. Please break this out by individual VACO offices (for example, Office of the Secretary, Office of General Counsel, Office of Policy
and Planning, etc.).
Response. In fiscal year 2015, a total 1,096 full-time equivalent employees (FTE)
in the General Administration account are supported through reimbursements. The
table below shows the number of FTE for each Staff Office and a brief description
of the associated program or activity.
Reimb.
FTE
General Administration Staff Office
Description/Activity
Office of the Secretary ..................................................
24
Office of Employee Discrimination Complaint Adjud.
Office of General Counsel .............................................
41
63
60
1
Credit Reform Administration

Medical Care Recovery Act
Contract Law Support (Supply Fund)
Specialized Legal Support
Office of Management ...................................................
10
24
7
Energy/Greening (OAEM)
Business Oversight (A123 & others)
Oversight Reviews of Supply Fund
Office of Human Resources Admin. ..............................
267
321
20
Office of Policy and Planning .......................................
27
Customer Data Integration
Office of Operations, Security and Prep. ......................
30
Identity Credentials and Access Mgt. (HSPD-12)
Office of Public and Intergov. Affairs ...........................
Office of Acquisition, Logistics and Const. ..................
140
48
7
2
Total ......................................................................
1,096
Office of Resolution Management

Human Capital Investment Plan
VACO Campus Administration
Homeless Veterans Outreach

Resident Engineers Support for Const. Projects
Leasing (Medical Facilities)
Supply Fund Management
Support to NCA
Question 33. The fiscal year 2015 budget request for VA proposes the creation of
a $1 billion Veterans Job Corps. This is the third year the proposal has been included in the Departments budget request. However, even though the Committee
has previously asked VA to provide more detailed information on the Veterans Job
Corps proposal, the Committee has not been provided with additional detail.
A. Historically, employment programs have not been a core mission of the Department. Why has VA been tasked with undertaking the program and not the Department of Labor, which focuses almost entirely on employment?
Response. VA carries out a robust set of activities related to Veterans employment. A few examples include hosting job fairs for Veterans; providing on-the-job
training and apprenticeship opportunities through the Post-9/11 G.I. Bill program;
delivering career counseling to Veterans in the VetSuccess on Campus program; administering the Veterans Vocational Rehabilitation and Employment program; and
partnering with the Departments of Defense and Labor in Transition GPS, a program that helps separating Servicemembers transition to the civilian workforce.
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B. Will veterans who participate in this temporary program receive any occupational licenses, certificates, or degrees that can be used in the civilian labor market?
Response. The goal of the Veterans Job Corps is to enable Veterans to leverage
the skills developed in the military into jobs on the countrys public lands and in
its communities, ranging from conservation and infrastructure projects to law enforcement and first responder jobs, such as park rangers, police officers, and firefighters. VA would like to work with the Congress to pass legislation to authorize
the Veterans Job Corps and address details such as credentialing and the programs
linkages to VAs certificate, licensing, and degree-granting programs, such as the
Post-9/11 G.I. Bill.
C. Will there be any guarantee of permanent employment for the veterans who
participate in this program?
Response. VA would like to work with the Congress to pass legislation to authorize the Veterans Job Corps and address details such as post-program employment
opportunities for Veterans who participate in the program.
READJUSTMENT BENEFITS
Question 34. One item that VA pays for using mandatory funding is reporting fees
provided to educational institutions. For fiscal year 2013, please provide the number
of institutions that received reporting fees, the 10 largest payments made to an institution, and the number of institutions that received total payments of $15 or less.
Response. In FY 2013, VBA paid $10.4 million in reporting fees to 10,578 institutions. Incorporating recoveries from these institutions, net payments were $10.2 million, as shown in the FY 2015 Department of Veterans Affairs Budget Submission
(Volume 3, pg. VBA32). The chart below shows the ten largest payments made to
an institution in FY 2013. Additionally, in FY 2013, 1,664 institutions received total
payments of $15 or less in reporting fees.
School Name
Total Paid
University of Phoenix (Online) ..................................................................

American Public University System (American Military University) .........
Ashford University (Online) .......................................................................
University of Maryland University College ................................................
Liberty University ......................................................................................
Grantham University .................................................................................
Kaplan University ......................................................................................
Columbia Southern University ..................................................................
Central Texas College ...............................................................................
University of Phoenix (San Diego) ............................................................
$339,132
$169,596
$143,835
$91,740
$79,119
$75,600
$72,060
$59,076
$55,752
$51,372
Question 35. The authorization for certain work-study activities expired in

June 2013. Those work-study activities include outreach programs with State approving agencies, working in State homes, and administration of a national cemetery or state veterans cemetery. During fiscal year 2013, how many individuals participated in each of those work-study activities?
Response. The table below provides FY 2013 data related to the number of individuals performing work-study activities at SAAs, state homes, and administration
of a national cemetery or state Veterans cemetery.
FY 2013 Work-Study Activities

Activity/location
# of
individuals
SAAs ..........................................................................................................
State homes ..............................................................................................
Administration of a national cemetery .....................................................
State Veterans cemetery ...........................................................................
36
75
84
19
Question 36. On March 5, 2014, both the House and Senate Committees on Veterans Affairs were informed by VA that the Veterans Retraining Assistance Program (VRAP) would be extended to make payments past the statutory sunset date
to participating veterans whose training program will not be completed by
March 31, 2014. Subsection (a)(2) of section 211 of Public Law11256, the VOW to
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Hire Heroes Act of 2011, which established VRAP, explicitly sets the number of veterans who could participate and limits participation to on or before March 31, 2014.
A. Subsections (a)(2) and (k) establish March 31, 2014, as the sunset date of the
program. What statutory authority exists in section 211 to allow for the extension?
Response. In February 2014, it became apparent that as many as 22,000 Veterans
might be unable to complete their current term of enrollment in Veterans Retraining Assistance Program (VRAP) courses of study before the authority to issue VRAP
payments expired on March 31, 2014. Many Veterans receiving retraining assistance
were enrolled in community colleges or other programs on a typical academic calendar, and while enrollment periods vary from school to school, spring semesters
and quarters are generally completed by the end of June. Without the assistance
provided by VRAP, Department of Veterans Affairs (VA) was concerned that many
of these Veterans would be forced to withdraw from their retraining programs in
the middle of the academic term. That would be both terribly disruptive and inconsistent with the purpose of ensuring Veterans gain the skills they need. In some
cases, it might also mean that a Veteran would not obtain the degree or certificate
they would otherwise receive if allowed to finish their current enrollment period.
Accordingly, VAs Office of General Counsel examined the relevant statutes to determine whether it would be possible to make payments prior to March 31, to assist
those Veterans in finishing their term and thereby maximize the benefits provided
through this valuable program. OGCs review concluded that there was no statutory
bar to issuing payments prior to the March 31, 2014 deadline to cover multiple
months. OGC further concluded that a policy decision to exercise VAs discretion
and make one-time payments to enable completion of ongoing training would further
Congress intent with regard to the program, namely to ensure that Veterans are
retrained so that they can begin new careers. OGCs analysis focused on the text
of the relevant statute, section 211, which does not set a date on which the program
must end, nor does subsection (a)(2) prohibit participation by veterans after
March 31, 2014. Instead, subsection (k) of the statute provides that [t]he authority
to make payments under this section shall terminate on March 31, 2014, and subsection (a)(2), which is entitled Number of Eligible Veterans, simply places a cap
on the number of Veterans eligible for the program.
VAs action is consistent with the statute because no payments to Veterans will
be made after March 31, 2014. And read closely, section 211(a)(2)(B) does not prohibit participation after March 31, but rather provides that the number of participants may not exceed 54,000. Similarly, section 211(c), entitled Monthly Certification, requires certification to the Secretary of enrollment for each month by
Veterans while participating in the program, but does not specify that those certifications be made monthly, nor does it address frequency of payments.
B. In order to receive a payment from VA for participating in VRAP, a veteran
has to certify monthly that he or she is a full-time student in an approved course
of study. The VA Office of Inspector General has previously found VA had difficulties verifying the attendance status of participating veterans, leading to VA making
millions in erroneous payments. Given the proposed payment of lump sum payments under the extension, how will VA ensure that millions more will not be
wasted?
Response. In order to be approved for the Veterans Retraining Assistance Program (VRAP), a program must be approved for GI Bill benefits under Chapter 36
of title 38 U.S.C. Consequently, the schools are required to report changes in enrollment (or failure to meet the schools standards of attendance, or conduct, as applicable) to VBA without delay. Without delay is defined by regulation as within 30
days. All approved programs are subject to periodic compliance reviews, which include reviewing records for VRAP participants in order to ensure that the schools
(and students) are meeting the applicable requirements. In addition, recipients of
VRAP one-time payments are specifically required, and instructed, to notify VBA
immediately of changes in enrollment status. This requirement also applies to recipients of one-time payments issued under the various GI Bill programs as well.
VETERANS BENEFITS ADMINISTRATION
Disability Compensation
Question 37. The Winston-Salem regional office helps with national missions, such
as the Benefits Delivery at Discharge program and the Quick Start program, in addition to handling claims from North Carolinians. That office currently has over
30,000 pending claims. For that workload, how many employees would be appropriate and how many are there currently?
Response. VBAs RAM is a systematic approach to distributing field resources
each fiscal year. The RAM utilizes a weighted model to assign C&P FTE resources
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based on RO workload, including rating inventory and rating, non-rating, and appeal receipts. Starting in FY 2014, the RAM includes additional variables to more
closely align with VBAs transformation to a paperless, electronic environment,
where receipts can be assigned and managed at the national level. These variables
include station efficiency, quality, and RO capacity. Based on the FY 2014 RAM, the
Winston-Salem RO FTE allocation for disability compensation claims processing was
614 FTE. Nine additional FTE were approved in March 2014 due to increased workload. As of March 30, 2014, the number of FTE on board was 615.
Question 38. The fiscal year 2015 budget request does not include projections for
how long it will take to complete compensation and pension claims in fiscal years
2014 and 2015. In fact, the budget books reflect that this performance measure has
been deleted.
A. What are VAs projections for how long it will take to complete disability claims
in those years?
Response. In FY 2013, the average days to complete (ADC) rating-related claims
was 348 days, a reflection of VBAs emphasis on completing the oldest claims in the
backlog during the second half of FY 2013. That emphasis continued through the
first quarter of FY 2014, which ended with an ADC of 277 days for the quarter.
ADC through the end of the first half of FY 2014 further declined to 253 days. We
expect this trend to continue through the remainder of FY 2014 and into FY 2015.
By the second quarter of FY 2015, we expect the downward trend in the monthly
ADC to begin accelerating, leveling out to approximately 100 days for the last quarter of FY 2015.
B. Why is this metric being deleted from the budget request?
Response. VBAs Agency Priority Goal is to eliminate the backlog and process all
claims within 125 days in 2015. Both metrics, ADC and Average Days Pending
(ADP), remain important metrics to track. As we drive toward our goal, VBA implemented an initiative in April 2013, to process oldest claims first, which results in
the ADC increasing in the short-term, even as we make great progress in eliminating the backlog for Veterans who have waited the longest for a decision. ADP
is a leading indicator that provides the best measure of the current state of the
claims inventory, and is the most meaningful way for Veterans to understand how
long their claim may take to process. The average number of days rating claims are
pending has been reduced from a peak of 282 days in March 2013, to 161 days as
of April 5, 2014, which represents a 43-percent reduction. The number of claims in
the backlog has been reduced from a peak of 611,000 to 337,000 as of April 5, 2014,
a 45-percent reduction.
Question 39. The number of dependency adjustments waiting for VA action increased from less than 50,000 in 2010 to nearly 240,000 in March 2014. As of
March 2014, 75 percent of the dependency adjustments have been pending for longer
than 125 days.
A. When does VA consider a dependency adjustment to be backlogged?
Response. There is no defined parameter for a backlogged dependency adjustment; however, we do track them against the 125-day goal for all disability claims.
B. What performance metrics does VA have in place with respect to dependency
adjustments and how quickly they should be acted on? With on-going efforts to increase the automation for processing these work items, will those performance
metrics change?
Response. Each RO has a target for reducing the inventory of pending dependency
adjustments. VBA is working on several initiatives that streamline the processing
of dependency claims. Current and upcoming initiatives that will help improve the
speed and accuracy of dependency claims processing are provided below.
Veterans can now request to add dependents using the eBenefits portal. VBAs
rules-based processing system (RBPS) automatically processes over 50 percent of the
dependency requests submitted through eBenefits and automatically adjusts compensation payments based upon the change in dependent status. This new automated system reduces processing time to one day for many of these requests and
allows VBA to devote more resources to processing other, more complex claims.
In the past year, VBAs Compensation Service (CS) released several dependency-related procedural changes that simplify the decision process and relax evidentiary standards. These include:
Liberalizing evidentiary requirements for stepchildren, under which VBA will
accept a Veterans lay statement as sufficient proof to establish a stepchild as
a dependent, provided that the statement includes basic information about the
dependency change. VBA will request additional evidence to support the claim
only when it has a reason to question the validity of the statement.
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Streamlining procedures when the beneficiary does not provide VBA information sufficient to determine entitlement dates. VBA will attempt to contact the
Veteran by phone to obtain the date of the dependency change and process the
change based upon information provided during the call.
CS is working to further relax evidentiary requirements and streamline the procedures for processing dependency claims. This initiative includes issuing additional
procedural guidance to the ROs and evaluating current regulations for the purpose
of initiating appropriate rulemaking to remove unnecessary processes.
New functionality is being developed for VBAs Customer Relations Management Unified Desktop, which is utilized by VBAs agents in its National Call Centers (NCC), which will allow the system to send dependency claims that the NCC
agents receive over the phone to RBPS for automated processing.
As automation of dependency claims continues to improve, more of these claims
will be processed with greater efficiency and improved timeliness. VA will set FY
2015 performance metric goals that take into consideration inventory levels and the
level of automation at that time.
C. Has VA set any timelines, milestones, or goals for when this inventory of dependency adjustments will be reduced to an acceptable level?
Response. With VBAs record-breaking production of claims decisions in recent
years, dependency claims are also rising. To address the rise in claims, VBA built
a RBPS to automate processing and payment of dependency claims for Veterans
who file online. Over 50 percent of dependency claims that are filed online are now
being completed without human intervention. The remaining 50 percent are immediately triaged to make it easier for the claims processor to target the needed evidence for resolution. This new IT capability will enable future claims filed online
to be completed quickly and accurately, and as a result, our Veterans will receive
their payments much faster. On April 4, 2014, VBA awarded a contract to provide
surge support to complete paper-based dependency claims. Contract personnel will
enter data from paper claims into RBPS, which will allow a significant portion of
these claims to be electronically processed and adjudicatedjust as if the Veteran
had input the data. VA also recently trained its call center agents to resolve dependency claims issues over the phone to expedite those claims already in the system.
ADC for a dependency claim in March 2014 was 207 days, down 75 days from the
first quarter of FY 2014.
Question 40. According to the authors of the fiscal year 2015 Independent Budget,
the most significant change that has helped reduce the backlog over the past year
has been [the Veterans Benefits Administrations] heavy reliance on mandatory
overtime.
A. Of the 1.17 million claims completed during fiscal year 2013, what portion was
completed as a result of overtime?
Response. VBA spent $71 million on overtime for direct C&P-related claims processing, resulting in a conservatively estimated 91,000129,000 additional claims
completed.
B. So far during fiscal year 2014, how many claims have been completed in total
and what portion was completed as a result of overtime?
Response. Through the first two quarters of FY 2014, 631,000 rating-related
claims have been completed. VBA estimates 65,00070,000 of the claims completed
to be attributed to overtime.
C. What portion of any increase in productivity during fiscal years 2013 and 2014
has resulted from other initiatives, such as the Veterans Benefits Management System or segmented lanes? At this point, is VA seeing a reasonable return on investment for those other initiatives?
Response. VBMS is projected to increase productivity in FY 2014; however, it is
difficult to extract the impact of each transformation initiative from the combined
people, process, and technology model that are being concurrently implemented to
determine individual initiatives contribution to productivity outcomes.
VBA has seen improvements in performance as a result of its transformation initiatives. As of May 22, 2014, VA has completed 833,000 claims in FY 2014, a 26percent increase over the same time last year and a 32-percent increase over two
years ago. VBA has also significantly reduced its inventory and backlog. As of
May 22, 2014, there were 574,000 claims pending in VBAs inventory, which represents a 34-percent reduction from July 2012 when the inventory peaked at
884,000 claims. Similar improvements can be seen in the claims acklog (i.e., pending
over 125 days). As of May 22, 2014, 293 claims were in the backloga 52-percent
reduction since the backlog peaked in March 2013.
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D. What specific initiatives are expected to allow VA to handle more claims in fiscal year 2015 than this year and what statistics or information suggests that a 17
percent increase in productivity is realistic?
Response. VA is focused on providing a long-term solution to a decades-old problem. VBA is retraining, reorganizing, streamlining business processes, and building
and implementing technology solutions based on the newly redesigned processes to
improve benefits delivery. Several transformation initiatives, as described below, are
focused on increasing the number of ratings completed per FTE. VBA is also completing a thorough evaluation of its ability to meet the processing demands of incoming workload, through demand and capacity analyses, which are currently in
progress.
VBAs new organizational model, which incorporates a case-management approach
to claims processing, has been implemented at all 56 ROs. VBA projects that the
segmented lanes initiative, part of this new organizational model, will accelerate
simpler claims, predictably taking less time through the express lane, with the remainder of claims flowing through either a special operations lane (claims requiring special handling) or core lane. This segmented, case-management approach to
claims processing is creating efficiencies within the workforce.
VBMS, VBAs Web-based electronic claims processing system, was deployed to all
56 ROs 6 months ahead of schedule in June 2013. VBA has also successfully deployed VBMS to the Appeals Management Center (AMC), the Records Management
Center, the Board of Veterans Appeals (Board), all NCCs, and all VA medical centers. VBA is confident in its Transformation Plan. Even during the year of change,
VBA was able to increase production by 12 percent in FY 2013 over
FY 2012. This is a clear indication that success will continue during FY 2014 and
culminate in the people, process, and technology improvements that allow for our
17 percent forecasted increase in FY 2015.
Throughout 2014 and 2015, VBMS will focus on continuing to improve electronic
claims processing by providing increased system functionality and more complex automation capabilities for all VBMS end-users. VBMS enhancements will reduce dependency on legacy systems for claims establishment, development, and rating.
VBMS now has the capability to accept electronic Veterans Service Treatment
Records (STR) from DOD. Additionally, VBMS end-users (to include VA Medical
Center personnel and VSOs) will be able to leverage enhanced system functionality
to perform their work more efficiently and accurately. Development of functionality
will provide end-users with the ability to process claims electronically from receipt
to payment. The addition of functionality and stabilization of system capabilities, in
conjunction with business process improvements, will increase production and quality of claim decisions.
VBAs partnership with VSOs is crucial to our transformation. VBA is greatly expanding education and collaboration efforts with VSOs that result in the submission
of more fully developed claims (FDC)claims that come to VBA ready for final review and decision (http://www.benefits.va.gov/fdc/).
VBA is also completing the integration with other Federal agencies that enables
inter-departmental data review and exchange to support pension and disability
claims processing. This includes Social Security Administration (SSA) and Internal
Revenue Service (IRS) (income verification), and DOD (military personnel and medical records).
Question 41. According to information provided in connection with the fiscal year
2014 budget request, the Veterans Benefits Administration (VBA) planned to expend $40 million in fiscal year 2014 to pay for claims processing staff to work overtime.
A. During fiscal year 2013, how much in total was actually expended to pay for
overtime work by claims processing staff?
Response. In FY 2013, VBA expended a total of $71 million on overtime for C&P
rating claims processing.
B. During fiscal year 2014, how much is now expected to be spent on overtime
by claims processing staff and what outcomes are expected to be achieved as a result of those overtime hours?
Response. VBA anticipates using approximately $100 million to fund overtime for
C&P rating claims processing in FY 2014, and estimates completing approximately
168,000 claims associated with overtime funding.
C. For fiscal year 2015, what level of funding is requested to pay for overtime
hours worked by claims processing staff and what outcomes are expected to be
achieved as a result of those overtime hours?
Response. VBA anticipates using approximately $60 million to fund overtime for
C&P rating claims processing in FY 2015, and estimates completing approximately
101,000 claims associated with overtime funding.
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Question 42. VA is now projecting that it will complete about 1.25 million disability claims this year. That is about 72,000 less completed claims than VA projected in the budget request last year and 370,000 less than projected in VAs 2013
backlog reduction plan. What led to these decreases in the expected productivity for
fiscal year 2014? Are there initiatives that are not having the expected impact on
productivity yet?
Response. The projections of received and completed claims in VBAs 2014 budget
and VAs Strategic Plan to Eliminate the Compensation Claims Backlog were based
on assumptions made earlier in the budget cycle that included a higher level of
claims receipts and FTE. Projections are periodically updated based on recent experience, the impact of the transformation initiatives, and enhanced forecasting capabilities.
Question 43. VA has a number of initiatives underway to reach its goal of a 98
percent accuracy rate.
A. In total, how much did VA spend in fiscal year 2013 to carry out all of those
quality initiatives?
Response. VBAs transformation plan is based on over 40 high-impact initiatives
across people, process, and technology through a systematic and repeatable gap
analysis process. It is difficult to separate each initiatives precise impact on quality
and productivity; however, the FY 2013 funding for four of the initiatives with the
greatest impact on quality is provided below:
VBMS: $51.1 million (VBA GOE program non-pay, non-IT funding for paperless
initiative)
Challenge training: $8.2 million
Quality Review Teams (QRT): $52 million
Station Enhancement Training (SET): $582,000
B. In total, how much is VA expecting to spend in fiscal year 2014 to carry out
all of those quality initiatives, including the quality review teams at each regional
office?
Response. As previously noted, several initiatives impact quality. A summary of
FY 2014 funding for the primary initiatives focused on improving quality is provided
below:
VBMS: $159.9 million (VBA GOE program non-pay, non-IT funding for
paperless initiative)
QRTs: $53 million
Training for underperforming claims processors: $10 million
C. In total, how much is VA requesting for fiscal year 2015 to carry out all of
those quality initiatives, including the quality review teams at each regional office?
Response. For FY 2015, VBA has requested the following funding for these initiatives:
VBMS: $162.5 million (VBA GOE program non-pay, non-IT funding for
paperless initiative)
QRTs: $57 million
D. Nation-wide, how many full-time equivalents are currently assigned to these
quality review teams?
Response. In April 2014, approximately 650 Quality Review Specialists were assigned to the QRTs nationwide.
E. If the fiscal year 2015 budget request is adopted, how many individuals Nationwide would be assigned to these teams?
Response. During the development and piloting of the QRTs, analysis showed an
appropriate staffing ratio of one Quality Review Specialist to every 15 claims processors. VBA anticipates continuing to utilize this staffing ratio for QRT positions
during FY 2014 and FY 2015; resulting in consistent staffing levels for both years.
Question 44. VAs appeals resolution time in fiscal year 2013 was 923 days, an
increase of 267 days since fiscal year 2010. Also, the number of pending appeals has
increased by more than 30 percent over the past few years. Although VA recently
sent the Committee a plan to improve the appeal process, it does not have details
about when this inventory of appeals will be reduced.
A. How much in total is expected to be expended by VBA to process appeals during fiscal year 2014?
Response. In FY 2014, VBA estimates that funding for claims processors to process appeals will total $86.6 million. This includes funding for the approximately 900
claims processors at the ROs and the AMC.
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B. What level of funding is requested in total for fiscal year 2015 for purposes
of processing appeals by VBA?
Response. In FY 2015, VBA estimates that funding for claims processors to process appeals will total $89.3 million.
C. When does VA expect the inventory of appeals to start to decline and when
will it reach a level that VA considers acceptable? Please provide any goals,
timelines, or milestones that VA has set with regard to the reduction in pending
appeals.
Response. The rate of appeals (approximately 11 percent) has remained steady
over last 20 years, regardless of quality or production. As more claims are completed, more appeals are received. VAs large inventory of pending appeals is due
in part to the record number of claims VBA has completed over the past four years.
VA expects to complete well over a million claims again in FY 2014.
As noted in VAs Strategic Plan to Transform the Appeal Process, which was provided to the Senate Committee on Veterans Affairs on February 26, 2014, the current process provides appellants with multiple reviews in VBA and one or more reviews at the Board, depending upon the submission of new evidence or whether the
Board determines that it is necessary to remand the matter to VBA. Although VA
has allocated significant resources to the appeals workload, the multi-step, openrecord appeal process set out in current law precludes the efficient delivery of benefits to all Veterans. The longer an appeal takes, the more likely it is that a claimed
disability will change, resulting in the need for additional medical and other evidence. VA is implementing a series of initiatives to improve the appeal process and
continues to work with Congress and other stakeholders to explore long-term solutions that would provide Veterans the timely appeals process they deserve.
VBA has established the following strategic targets for appeals:
Veterans Appeals Control Time7 days
Veterans Appeals Pending (across all ROs)174,945
Veterans Appeals ADP182 days
VA Form 9 ADP320 days
Question 45. In the fiscal year 2015 budget request, the discretionary request for
the disability compensation program includes $557 million for Other Services.
Please provide a detailed itemized list of how that funding would be utilized during
fiscal year 2015. To the extent any of the funds will be spent on contracts, please
explain the nature of the contract and the expected outcomes.
Response. The discretionary request for $557 million contains funding of $440.4
million for contracts that directly impact or support the delivery of disability compensation claims:
Contract Medical Examinations ($250.8 million)
Veterans Claims Intake Program (scanning) ($134.4 million)
Program management and systems engineering support services for the VBMS
($32.8 million)
Development of instructional methodologies and systems that support the training and skills development of the disability compensation workforce ($8.3 million)
Development of the Centralized Mail Processing System ($7.8 million)
Program management, scientific, technical, and engineering support for Compensation Service and the VBA Operations Center ($6.3 million).
The request also includes $32.4 million for studies and analyses that support strategic planning ($16.7 million) and innovation ($15.7 million).
The remaining $83.8 million is for administrative and management support costs
associated with VBA-internal support agreements, such as Franchise Fund fees for
Debt Management Center, Financial Services Center, Computer Data Center Operations services, and for support attained via interagency agreements with the Department of Homeland Security, the Department of the Treasury, and the National
Archives and Records Administration.
Question 46. According to the fiscal year 2015 budget request, the disability compensation program expects to spend $33 million on travel during fiscal year 2014,
which is $15.8 million higher than the amount spent during fiscal year 2013 and
$10 million higher than the amount originally requested for fiscal year 2014. What
factors led to this increase in expected travel expenditures?
Response. The primary factor that led to this increase is the $10 million appropriated for targeted training for claims processors to increase production and help
eliminate the claims backlog. Additionally, Challenge Training classes were sourced
at a planned throughput of 220 seats per class.
Question 47. In response to questions about the fiscal year 2014 budget request,
VA indicated that VA completed approximately 81 claims per direct full-time equiv-
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alent in fiscal year 2013 and expected to complete at least 90 claims per full-time
equivalent in fiscal year 2014 and at least 100 claims per full-time employee in
2015. To date in fiscal year 2014, how many claims have been completed per compensation and pension direct labor full-time equivalent?
Response. FY 2014 through the end of March, C&P direct FTE completed an average of 47.4 claims per FTE. VBA is on target to reach 90 claims per FTE by the
end of the fiscal year.
VA indicated that VA expected to receive more than 200,000 fully-developed claims
in fiscal year 2014 and expected it to take on average 100 days to process those
claims.
A. How many fully-developed claims are now expected to be filed during fiscal
year 2014 and during fiscal year 2015?
Response. VBA expects to receive more than 380,000 FDCs in FY 2014 and more
than 485,000 FDCs in FY 2015.
B. To date in fiscal year 2014, how many days on average is it taking to complete
fully-developed claims?
Response. Through March of FY 2014, FDCs have been completed in an average
of 144 days.
C. For fiscal year 2015, how long is it projected to take to complete fully-developed
claims?
Response. VA projects to complete FDCs in 125 days or less in 2015, with a September 2015 monthly target of 90 days to complete FDCs.
D. For fiscal year 2014, how much is expected to be spent on marketing materials
for the fully-developed claims program and related training?
Response. VBA expects to spend $1.4 million on materials that promote the FDC
program. This dollar amount is comprised of expenditures on contracts for:
Promotional materials
VBA translation services
FDC and training support
FDC eBenefits campaign
E. For fiscal year 2015, what level of funding is requested for purposes of promoting the fully-developed claims program?
Response. VBA requested approximately $941,000 in the FY 2015 budget submission.
VA indicated that it was requesting $10 million in order to contract with private
entities to retrieve medical records from private medical providers.
A. In total, how much was spent on that initiative during fiscal year 2013 and
what was the average time it took the contractors to obtain private medical records
(or otherwise close out the development action)?
Response. In FY 2013, VBA obligated $2.1 million to continue the Private Medical
Records (PMR) initiative. The contractor resolved PMR requests, either by obtaining
PMRs or otherwise completing development action, in an average of 12 days.
B. How much is now expected to be spent on this initiative during fiscal year 2014
and how long on average is it currently taking the contractors to obtain private
medical records (or otherwise close out the development action)?
Response. In FY 2014, VA plans to spend $9.3 million on the PMR initiative. In
FY 2014 through April 3, 2014, the contractor resolved over 114,000 PMR requests
in an average of 12 days.
C. Is any funding requested with respect to this initiative for fiscal year 2015?
If so, please specify the amount.
Response. For FY 2015, VA is requesting $15.7 million to support the ongoing
costs of the nationally implemented PMR program.
VA indicated that it expended $366,139 in fiscal year 2012 for purposes of updating
the disability rating schedule. The fiscal year 2015 budget request reflects that
VBA projects that it will complete its review of the 15 body systems in the rating
schedule by December 2016.
A. During fiscal year 2013, how much was spent with respect to efforts to update
the disability rating schedule?
Response. In FY 2013, VBA spent approximately $981,000 to support updates to
the VA Schedule of Rating Disabilities (VASRD), including $902,000 for personal
services, $30,000 for travel, and $49,000 for rent, supplies, and other services.
B. During fiscal years 2014 and 2015, how much is expected to be spent with respect to efforts to update the disability rating schedule?
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Response. In FY 2014, VBA will spend approximately $996,000 to support updates
to VASRD, including $947,000 for personal services, $3,000 for travel, and $46,000
for rent, supplies, and other services. In FY 2015, VBA requested $3.0 million to
update the VASRD, including $952,000 for personal services, $30,000 for travel, and
$2.0 million for other services. The increased in funding in FY 2015 is primarily due
to a contracted earnings loss study.
C. Of those 15 body systems, how many will be addressed by regulations published during the remainder of fiscal year 2014 and how many will be addressed
by regulations published during fiscal year 2015?
Response. Under the Project Management Plan, none of the VASRD body systems
will be addressed by regulations published during FY 2014. VA will address each
of the 15 body systems with a notice of proposed rulemaking published in the Federal Register by fall 2015, allowing 60 days for public comments. Subsequently, VA
will review public comments and revise the proposed rules as appropriate before
publishing them as final.
VA estimated that about $663,000 had been spent on earnings loss studies needed
to complete revisions of the disability rating schedule but that the contract had been
terminated before the final report had been provided. VA indicated that, through
this spending, it learned that due to statutory limitations, individualized earnings
data cannot be obtained from the Internal Revenue Service.
A. Please explain what, if any, information was obtained as a result of that
$663,000 in expenditures that could be used to complete the revisions to the rating
schedule?
Response. VA received six of the nine contract line item numbers outlined in the
contract with George Washington University for an earnings loss study. VA does not
expect any more deliverables to be provided under this contract. The six deliverables
provided to VA are as follows:
1. Obtained Security Clearance: The contractor completed all paperwork, provided all background information, and completed all training courses necessary
to secure security clearance and authorization to use VA databases and perform
tasks on VA property.
2. Lessons Learned Report: The contractor reviewed VASRD and prior earnings loss studies. The contractor prepared and delivered a written report identifying important lessons learned through previous earnings loss studies and developed a strategy for providing an improved earnings loss study.
3. Comprehensive Draft Project Management Plan (PMP), Final PMP, and
Leadership Briefing: The contractor provided VA with a copy of a PMP detailing
a plan for accomplishing the tasks and subtasks.
4. Data base of Service-Connected Disabled Veterans: The contractor provided
a database set, based on a compilation of data gathered from VA, including a
sample of service-connected disabled Veterans, rating information, and other
data points such as Social Security numbers, dates of birth, names, and disabilities. The contractor coordinated sampling methodology across the various data
sets to ensure consistency, representativeness, and confidentiality.
5. Approach Plan and Briefing: The contractor briefed VA leadership on a
plan to address each aspect of the contract deliverables, identifying an obstacle
in receiving required data. IRS and SSA provided the contractor with data
encrypted into groups, and the contractor was unable to assess the impact of
earnings losses based on individual service-connected disabilities compared to
the control group.
6. Earnings Loss Model: VA requested a systematic analysis of compensation
payments for disabilities associated with body system profiles and rating criteria identified in VASRD. The contractor delivered a formula with variables to
evaluate all earnings loss databased on individual service-connected disabilities.
However, due to the lack of individually identified data from the IRS and SSA,
the contractor was unable to insert the data into the formula. Without the necessary data, the formula did not provide VA with the requested information.
B. Was VAs Office of General Counsel consulted about possible statutory limitations before VA entered into a contract for these earnings loss studies?
Response. Yes, VAs Office of General Counsel (OGC) was consulted prior to the
execution of the contract for the earnings loss study. The contract was tailored to
meet the specific needs of the earnings loss study and ultimately approved by OGC.
Upon encountering the statutory limitations regarding the release of individual income data, VA contacted IRS OGC. IRS informed VA that the release of individual
data for the purpose of the study was specifically prohibited by statute. After IRS
confirmed the statutory prohibition, the period of performance for the initial con-
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tract expired. A revised statement of work was prepared, stating that George Washington University was only authorized to complete the terms of the contract using
aggregate data and could not condition the completion of the contract upon receipt
of individual data.
C. Does the fiscal year 2015 budget request include any funding for earnings loss
studies? If so, please specify the amount and the expected deliverables from any
such studies.
Response. The FY 2015 budget request includes $2.5 million for external earnings
loss studies in support of ongoing and future VASRD revisions. Formulation of any
such studies has not begun; therefore, VA cannot state with any degree of certainty
what deliverables will be derived from such studies.
Question 52. VA and the Department of Defense (DOD) have rolled out worldwide
an Integrated Disability Evaluation System (IDES), through which an injured or ill
servicemember, before being medically discharged from the military, completes both
the DOD disability rating system and the VA disability rating process.
A. During fiscal year 2013, how much in total did VA expend with respect to the
Integrated Disability Evaluation System and how many VA employees were dedicated to the IDES process?
Response. During FY 2013, VBA spent approximately $70.7 million for salaries
and other GOE for 643 FTE dedicated to disability claims processing in the IDES
process. Compensation staff and VR&E counselors are included in this count. Veterans filing claims through the IDES sites are captured in the nationwide Veteran
caseload count and total compensation benefit obligations; therefore, mandatory
funding cannot be separated for this program.
B. During fiscal year 2014, how much in total does VA expect to expend with respect to the Integrated Disability Evaluation System and how many VA employees
will be dedicated to the IDES process?
Response. During FY 2014, VBA estimates it will spend approximately $71.9 million for salaries and other GOE to support 648 FTE dedicated to disability claims
C. During fiscal year 2015, how much in total is VA requesting with respect to
the Integrated Disability Evaluation System and how many VA employees would
that level of funding support?
Response. During FY 2015, VBA estimates it will spend approximately $74.1 million for salaries and other GOE to support 648 FTE dedicated to disability claims
Pension and Fiduciary Service
Question 53. According to the Monday Morning Workload report for March 8,
2014, the Pension Management Center in Philadelphia, PA, had over 21,000 pending claims and 52 percent had been pending for longer than 125 days. By comparison, the Pension Management Center in St. Paul had 9,600 pending claims and less
than 20 percent had been pending for longer than 125 days.
A. How many full-time equivalent employees are currently assigned to each Pension Management Center and how many are expected to be assigned to each Pension Management Center during fiscal year 2015?
Response. For FY 2014, the Pension Management Centers (PMC) have a combined
allocation of 1,145 FTE. The Philadelphia PMC is allocated 430 FTE; Milwaukee
PMC is allocated 340 FTE; and the St. Paul PMC is allocated 375 FTE. Staffing
levels are expected to remain the same in FY 2015. The allocations are based on
VBAs RAM. The RAM utilizes a weighted model to assign C&P FTE resources
based on workload.
B. How many claims are expected to be received by each Pension Management
Center during fiscal year 2014 and during fiscal year 2015?
Response. VBA estimates that the three PMCs will receive approximately
140,000150,000 claims in the rating-related category during FY 2014 and 150,000
160,000 in FY 2015.
C. How many claims are expected to be completed by each Pension Management
Center during fiscal year 2014 and fiscal year 2015?
Response. Expected production from the three PMCs in FY 2014 is 160,000
170,000 claims, with a similar amount in FY 2015.
D. For each Pension Management Center, how many veterans died in fiscal year
2013 and to date in fiscal year 2014 after a decision on their claim had been rendered but before they received a retroactive award of pension benefits? In how many
of those cases were the retroactive benefits paid out as accrued benefits?
Response. During FY 2013, VA PMCs released retroactive benefit payments to
354 Veterans who had died on or before the date of an award of benefits was processed. As of April 9, 2014, VA has paid these retroactive payments as accrued bene-
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fits in 41 cases. For FY 2014 through April 9, 2014, the PMCs released retroactive
payments to 183 Veterans who had died on or before the date of an award of benefits was processed. As of April 9, 2014, VA has paid retroactive payments as accrued
benefits in 47 cases. A breakdown of this data by pension management center is
provided below:
Number of cases where the
Veteran died prior to receiving
their retroactive payment
Pension Management Center
Number of cases VA paid

retroactive payment as
accrued benefit
FY 2013
FY 2014 thru
April 9, 2014
FY 2013
FY 2014 thru
April 9, 2014
Milwaukee, WI ................................................................................
Philadelphia, PA .............................................................................
St. Paul, MN ...................................................................................
135
116
103
60
58
65
28
8
5
10
11
26
TOTAL .....................................................................................
354
183
41
47
E. For each Pension Management Center, how many veterans were declared incompetent during fiscal year 2013 and to date in fiscal year 2014; how long on average did it take for a fiduciary to be assigned to those veterans; and how frequently
did the veterans die before the assignment of a fiduciary had been completed?
Response. From October 1, 2012, through March 31, 2014, VA PMCs declared
42,436 beneficiaries (Veterans and Survivors) incapable of managing their funds.
The chart below provides the data for each PMC by fiscal year.
Incompetency
Decisions FY 2014
thru March 31,
2014
Pension Management Center
Incompetency
Decisions FY 2013
Philadelphia, PA ....................................
Milwaukee, WI ........................................
St. Paul, MN ..........................................
9,913
12,115
10,963
2,121
4,258
3,066
Total ..............................................
32,991
9,445
Nationally, the fiduciary hubs averaged 83 days to complete the appointment of

a fiduciary for a beneficiary who was rated incompetent in FY 2013. For FY 2014
through March 31, 2014, it took an average of 51 days to complete a fiduciary appointment. This timeliness data includes all incompetent C&P beneficiaries, both
Veterans and Survivors. VA systems cannot further categorize this timeliness information for pension only or by PMC.
Regarding Veterans who died before an initial fiduciary appointment was completed during FY 2013 through March 31, 2014, VA systems cannot categorize this
information by the PMC that issued the incompetency decision. However, for all
C&P incompetency decisions issued nationally for both Veterans and Survivors,
whether issued by a PMC or a RO Veterans Service Center, 376 beneficiaries passed
away before an initial fiduciary appointment was completed.
Question 54. In the fiscal year 2015 budget request, the discretionary request for
the pension, dependency and indemnity compensation, burial, and fiduciary programs includes $17.8 million for Other Services for fiscal year 2015. Please provide
a detailed itemized list of how that funding would be utilized during fiscal year
2015. To the extent any of the funds will be spent on contracts, please explain the
nature of the contract and the expected outcomes.
Response. The discretionary request for $17.8 million contains funding of $11.8
million for contracts that directly impact or support the delivery of pension claims:
Contract Medical Examinations ($2.3 million)
Program management, scientific, technical, and engineering support for Pension
and Fiduciary Service ($1.2 million)
Development of instructional methodologies and systems that support the training and skills development of the Pension and Fiduciary workforce ($8.3 million)
Debt Management Center, Financial Services Center, Computer Data Center Operations services, and for support attained via interagency agreements with the De-
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partment of Homeland Security, the Department of the Treasury, and the National
Question 55. According to VAs fiscal year 2013 Performance and Accountability
Report, the average days it took to complete a pension claim increased from 113
days in 2012 to 140 days in 2013.
A. During fiscal years 2012 and 2013, how many claims processing personnel were
dedicated to working on pension claims?
Response. In FY 2012, an average of 906 employees were dedicated to processing
claims at the PMCs. In FY 2013, there was an average of 905 employees. In addition to pension claims, these employees also processed dependency and indemnity
compensation (DIC), parents DIC, accrued, and monetary burial benefit claims, as
well as all related benefit adjustments.
B. For fiscal years 2014 and 2015, how many claims processing personnel are expected to be dedicated to working on pension claims?
Response. As of February 28, 2014, PMCs had 910 employees dedicated to claims
processing. VA expects this number to increase through FY 2014, as the PMCs bring
on an additional 35 employees to meet the PMCs FY 2014 allocation. VA does not
anticipate a change in the PMCs total staffing allocation in FY 2015.
Appeals Management Center
Question 56. Since 2003, certain cases remanded by the Board of Veterans Appeals (BVA or Board) have been handled at a centralized entity called the Appeals
Management Center.
A. During fiscal year 2013, how much was spent on the Appeals Management
Center and what level of staffing did that funding support?
Response. In FY 2013, $21.1 million was spent by the AMC for payroll, non-payroll, and travel. This supported staffing of approximately 228 FTE.
B. During fiscal year 2014, how much is now expected to be spent on the Appeals
Management Center and what level of staffing will that funding support?
Response. In FY 2014, approximately $20.6 million is expected to be spent by the
AMC for payroll, non-payroll, and travel. This is expected to support staffing of approximately 221 FTE.
C. In total, how much funding is requested for fiscal year 2015 for the Appeals
Management Center and what level of staffing would that funding support?
Response. VBA anticipates that the FY 2015 staffing levels will be consistent with
FY 2014 levels and therefore funding will also be consistent with FY 2014.
D. For fiscal year 2014, what are the key performance targets for the Appeals
Management Center?
Response. The FY 2014 AMC key performance targets consist of the following
metrics and corresponding targets:
ADP for remands from homeless Veterans70 days
Remand inventory7,500
ADP for remands75 days
ADC remands140 days
Remand production27,900
Accuracy of remand decision90 percent (3-months rolling)
Education
Question 57. According to the fiscal year 2015 budget request, the discretionary
request for Education programs includes $16 million for Other Services. Please provide a detailed itemized list of how those funds would be utilized during fiscal year
2015. To the extent any of the funds will be spent on contracts, please explain the
nature of the contract and the expected outcomes.
Response. The $15.9 million request contains funding of $5.4 million for contracts
that support Education Service, including:
Program management and systems engineering support services for the Post9/11 GI Bill ($4.4 million);
Development of instructional methodologies and systems to support the training
and skills development of the Education workforce ($608,000);
Publication and distribution of outreach pamphlets and letters to satisfy intent
of Public Law 101237 and Public Law 105368 ($242,000);
National Student Clearinghouse Contract for degree attainment data ($81,000);
and
SAA Contract to support the development and implementation of a RAM
($103,000).
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Debt Management Center, Financial Services Center, Computer Data Center Operations services, and for support attained via interagency agreements with the Department of Homeland Security, the Department of the Treasury, and the National
Question 58. According to the fiscal year 2015 budget request, the discretionary
request for Education programs includes $3.6 million for printing, compared to
$522,000 requested for fiscal year 2014. The budget request includes this explanation: Printing obligations increase $3.1 million primarily as a result of realigned
non-IT administrative obligations from the Office of Information and Technology to
VBA. Please provide a more detailed explanation of how these funds will be spent,
how they were previously accounted for in the budget, and the need for the change.
Response. The funding will be used for the centralization and modernization of
printing associated with Post-9/11 GI Bill claims processing. It will cover expenses
necessary for the printing of more than 3.6 million letters VA anticipates mailing
to Veterans and other eligible beneficiaries. The $3.1 million provides for the centralized printing performed at VAs information technology centers, and the
$522,000 provides for printing conducted at VBA regional processing offices. The
$3.1 million increase shown in the budget is not a new requirement. Instead, it
is a shift in accounting for costs of the Post-9/11 GI Bill program. In FY 2013 and
previous years, centralized printing and mailing of Post-9/11 GI Bill letters were
provided as an operating expense of the information technology centers. Although
printing and mailing functions may, at times, require information technology support, the functions are more operational. As such, in FY 2014 and beyond, the centralized printing and mailing costs for Post-9/11 GI Bill letters is being realigned
more appropriately as an operating expense of VBA.
BOARD OF VETERANS APPEALS
the Board indicated that it expects to spend over $2 million per year on costs (salary and benefits) of union representatives and costs (salary and benefits) of BVA
managers who work on labor relations matters, labor relations counsel, and other
labor relations support staff.
A. In fiscal year 2013, how much was actually expended for those purposes?
Response. In fiscal year (FY) 2013, the Board of Veterans Appeals (the Board)
spent a total $1,925,654 for labor relations matters, including $1,022,024 for costs
(salary and benefits) of union representatives, and $903,630 for costs (salary and
benefits) of Board managers, labor relations counsel, and other labor relations support staff who work on labor relations matters.
B. In fiscal years 2014 and 2015, how much is now expected to be spent for those
purposes?
Response. Based on historical data from FY 2002 to April 2014, the Board expects
to pay a total of approximately $2,307,582 in FY 2014 ($1,267,111 for costs (salary
and benefits) of union representatives and $1,040,471 for costs (salary and benefits)
of Board managers, labor relations counsel, and other labor relations support staff
who work on labor relations matters); and $2,380,610 in FY 2015 ($1,303,631 for
costs (salary and benefits) of union representatives and $1,076,979 for costs (salary
and benefits) of Board managers, labor relations counsel, and other labor relations
support staff who work on labor relations matters).
C. During fiscal years 2014 and 2015, how many hours of official time (or union
time) are expected to be paid for by the Board with Federal funding?
Response. Based on a historical data from FY 2002 to April 2014, the Board estimates paying for a total of approximately 17,077 hours of official union time (official
time) in FY 2014, and 17,261 hours of official time in FY 2015.
Question 60. According to the fiscal year 2015 budget request, the Board is requesting $3 million for Other Services for fiscal year 2015. Please provide an
itemized list of how these funds are expected to be spent during fiscal year 2015.
Response. The $2,975,200 for Other Services in fiscal year 2015 will be allocated
in the following manner:
Xerox ............................................................................................................................................
Transcription Services (2 Vendors) .............................................................................................
Promisel and Korn, Inc. Electronic Research Materials Service and Maintenance Contract ....
JD Power and Associates Contract for customer satisfaction analysis for hearing and nonhearing processes ..................................................................................................................
West Group Contract-On-line Access to Westlaw Legal Database for legal research by the
Boards judges and attorneys ................................................................................................
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$575,000.00
560,000.00
405,000.00
332,000.00
320,000.00
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Department of Homeland Security ..............................................................................................
Financial Service Center .............................................................................................................
Boards Share of VA Central Offices (VACO) Human Capital Investment Plan .......................
Office of Personnel Management ...............................................................................................
United Parcel Services Appellant Records Shipment Contract ..................................................
Defense Finance and Accounting Services .................................................................................
Security and Investigations Center ............................................................................................
Office of Resolution Management ..............................................................................................
NextCut Document Shredding Contract for disposition of sensitive materials .........................
VACO Services Cost ....................................................................................................................
VA Record Center and Vault .......................................................................................................
140,000.00
140,000.00
135,000.00
105,000.00
80,000.00
64,000.00
42,000.00
40,000.00
27,000.00
10,000.00
200.00
Total Other Services ...........................................................................................................
$2,975,200.00
GENERAL ADMINISTRATION
Office of the Secretary

Question 61. According to the fiscal year 2015 budget request, 88 FTE are requested for the Office of the Secretary. Please provide a list of the positions that
would be filled with that funding and the pay-grades for those positions.
Response. A list of 95 positions in the Office of the Secretary is provided below.
Grade
Number of Positions
Senior Executive Service

15
14
13
12
11
9
8
7
6
13
15
31
16
6
4
5
1
2
2
Question 62. In 2010, the VA Center for Innovation was established as part of the
Secretarys strategy to modernize the Department of Veterans Affairs and move the
agency into the 21st Century. Over the last several years, this office has focused
on piloting innovative ideas to support the Secretarys initiative.
A. Please provide the Committee with the amount of funding utilized for grants
during fiscal year 2013 through Industry Competitions, Employee Competitions,
Special Projects, and Prize Contests.
Response. Department of Veterans Affairs Center for Innovation (VACI) funding
is provided by Veterans Health Administration, Veterans Benefits Administration,
and Office of Information and Technology. VACI utilized funding as follows across
the categories mentioned above:
Industry Competition ................................
Employee Competition ..............................
Special Projects ........................................
Prize Competitions ....................................
$17,783,605
$15,475,594
$10,303,064
$0
Total ........................................
$43,562,263
B. Please provide the Committee with the amount of funding that would be available for grants during fiscal year 2015 through Industry Competitions, Employee
Competitions, Special Projects, and Prize Contests.
Response. Department of Veterans Affairs Center for Innovation (VACI) expects
funding in the amount of $56 million in fiscal year 2015. Exact disposition of these
funds across the Industry Competition, the Employee Competition, Special Projects,
and Prize Contests has yet to be determined. Please note that VACI typically utilizes the acquisition process rather than grant mechanisms when working with ex-
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ternal entities. Funding mechanism to support internal activities is dependent upon
the specifics of the project.
Office of General Counsel
Question 63. The Office of General Counsel is requesting $2 million for Other
Services for fiscal year 2015. Please provide an itemized list of how these funds
would be spent during fiscal year 2015.
Response.
Question 64. Within the Office of General Counsel, Professional Staff Group VII
represents VA before the U.S. Court of Appeals for Veterans Claims.
A. Currently, how many employees are assigned to Professional Staff Group VII
and what is the average number of active cases per attorney?
Response. Professional Staff Group (PSG) VII has 104 full-time equivalent employees onboard and 5 approved vacancies that are in the process of being filled.
The average number of active cases per attorney is 44. An active case is one in
which the Secretary has yet to file his dispositive pleading.
B. For fiscal year 2015, what level of funding is requested to support Professional
Staff Group VII and how many employees would that level of funding support?
Response.
FTE
PSG VII ...................................................
109
Funding
$15,818,532
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C. With the requested funding level, what would be the expected average number
of active cases per attorney during fiscal year 2015?
Response. The average number of active cases per attorney will be maintained in
the range between 45 and 50.
D. How many motions for extension of time did Professional Group VII file during
fiscal year 2013?
81
Response. Professional Staff Group VII filed a total of 1,864 extension motions in
fiscal year 2013.
E. How many motions for extension of time has Professional Staff Group VII filed
to date during fiscal year 2014?
Response. During the period between October 1, 2013, and March 31, 2014, Professional Staff Group VII filed approximately 1,296 extension motions.
VA indicated that implementation budget planning will occur in 2013 for the Regulation Rewrite Project. Then, on November 26, 2013, VA made this announcement:
After many years of collaborative work between VA and Veterans Service
Organizations (VSOs), the VA Compensation and Pension Regulation Rewrite Proposed Rule combines all previous iterations of the proposed rule
and will be posted on the Federal Register (www.regulations.gov) starting
November 27, 2013 for 120 days of public comment and review. However,
VA does not intend to publish a final rulemaking anytime soon * * *.
A. When was the determination made to indefinitely delay the final publication
of these regulations?
Response. The determination to delay the final publication of these regulations
until after Department of Veterans Affairs (VA) has successfully eliminated the
claims backlog was made in September 2011 in order to avoid conflicts with VAs
highest priority effort to eliminate the claims backlog in 2015. VA already had decided to honor the request of several Veterans Service Organizations (VSO) to provide the public with an additional opportunity to review and comment on the entire
body of proposed regulations before the new 38 CFR Part 5 regulations were published as final. Consequently, in November 2013, the Rewrite Project published its
21st proposed rule, which consolidated VAs responses to the 20 previous proposed
rules and solicited any additional comments from the public and VSOs. In 2014, VA
will review the comments, draft a final rule containing VAs responses, and draft
and publish any additional proposed rules necessary to keep the Rewrite Project up
to date until it can be implemented.
B. Are any funds requested for fiscal year 2015 to advance this project?
Response. The Secretarys delegate for the written portion of the Regulation Rewrite Project in the Office of the General Counsel, the Office of Regulation Policy
and Management, does not require additional funding. Funding necessary for implementing the Regulation Rewrite Project will be determined once the claims backlog
has been eliminated.
Question 66. In a 2013 report on VAs program for accrediting individuals to represent claimants seeking veterans benefits, the Government Accountability Office
reported that VA has dedicated only a few staff to administer its accreditation program, which has resulted in limited monitoring efforts and workload backlogs.
A. Currently, how many full-time equivalent employees are dedicated to VAs accreditation program?
Response. Currently we have approximately four full-time equivalent employees
(FTE) dedicated to the accreditation program:
3 FTEs for 3 legal assistants
Approximately 0.1 FTE for an Assistant General Counsel
Approximately 0.4 FTE for a Deputy Assistant General Counsel
Approximately 0.5 FTE total for 10 staff attorneys
B. How much funding is requested for the accreditation program for fiscal year
2015 and what level of staffing would that funding support?
Response. For fiscal year 2015, Office of General Counsel has allocated approximately $372,175.77 for the 4 FTEs dedicated to the accreditation program
Office of Management
Question 67. According to the fiscal year 2015 budget request, the Office of Management requests $41 million for Other Services for fiscal year 2015. Please provide
an itemized list of how those funds would be used.
Response. A major portion of the $41 million in Other Services includes $37.4
million in reimbursable authority that the Office of Management (OM) will collect
to provide services across the Department, including:
$33 million for Department-wide Defense Finance and Accounting Services payroll support;
$4 million for reviewing and testing internal controls over financial reporting,
as required by Appendix A of Office of Management and Budget Circular A123;
and
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$400,000 for operations support to the Department of Veterans Affairs (VA)
Center for Innovation.
The portion of the request for appropriated funding in Other Services is $3.6 million and includes:
$1 million for service level agreements for the Financial Services Center, Security Investigations Center, and other service and maintenance agreements for conducting normal operations;
$1 million for audit readiness and verification of annual financial reporting;
$320,000 for training related to the VA Learning University and Human Capital Investment Plan; and
The remaining balance of funds in Other Services is primarily for the Office of
Personnel Managements user fees related to USAJobs, USA Staffing, e-Classification and e-OPF (Official Personnel Folder) and for internal legacy automation services.
Question 68. According to the fiscal year 2015 budget request, the Office of Finance within the Office of Management manages the Debt Management Center.
A. For fiscal year 2015, what level of resources is expected to be used to operate
the Debt Management Center and what level of staffing would those resources support?
Response. The anticipated total expenses related to the Debt Management Center
for fiscal year 2015 is $28,632,384 supporting a staff of 229 full-time equivalent employees.
B. How many telephone lines does the Debt Management Center currently operate and how many would be operated during fiscal year 2015?
Response. The Debt Management Center (DMC) currently operates 192 incoming
toll-free telephone lines with our inbound 800 service. In fiscal year (FY) 2014, DMC
increased from 144 toll-free lines to 192 toll-free lines, which is a 35-percent increase in phone line capacity. This increase provides more Veteran access to the
DMC and further reduces blocked call situations. In FY 2015, we plan to continue
to provide that service level unless Veteran demand increases.
C. During fiscal year 2013, how many debts were referred to the Debt Management Center, what was the total value of those debts, and how much did the Debt
Management Center recoup?
Response. In fiscal year (FY) 2013, 769,443 Veterans Benefits Administration
(VBA) debts were referred to the Debt Management Center (DMC) totaling
$1,386,566,000. During FY 2013, the DMC recouped $1,202,023,000 in VBA debts.
In FY 2013, 810,853 Veterans Health Administration (VHA) debts were referred
to the DMC totaling $383,281,000. During FY 2013, the DMC recouped
$220,267,000 in VHA debts.
D. How many new debts are expected to be referred to the Debt Management
Center during fiscal years 2014 and 2015?
Response. The Debt Management Center (DMC) estimates 823,000 Veterans Benefits Administration (VBA) debts will be referred in fiscal year (FY) 2014 and
880,900 VBA debts will be referred in FY 2015.
The DMC estimates 379,597 Veterans Health Administration (VHA) debts will be
referred in FY 2014 and 386,435 VHA debts will be referred in FY 2015.
Office of Human Resources and Administration
VA indicated that initiatives undertaken through the Human Capital Investment
Plan are expected to have immediate, tangible, and measureable impact on the
services provided to veterans.
A. Please describe any measurable outcomes that have resulted from these initiatives to date.
Response. In support of the Secretarys vision to transform VA and equip employees to work in alignment with that vision, VA launched the Human Capital Investment Plan (HCIP). HCIP programs include those that improve VAs ability to hire
and retain high-quality employees, empower employees to advance their careers, improve their performance and skills, and increase their personal and professional development. All VA employees impact the services provided to Veterans. Trained and
high performing VA employees in support roles enable physicians, nurses, benefits
administrators, or cemetery operators to focus directly on serving our Veterans.
Quantifiable outcomes from HCIP funding to date include:
Provided over 2.3 million instances of leadership and managerial training
through the VA Learning University to improve employee performance and skills;
develop and enable VA employees to meet the rapidly changing healthcare and ben-
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efits environment; and to increase personal employee development and empower
employees to advance their careers and provide more precise and efficient service.
Trained over 30,000 managers and supervisors on mandatory Equal Employment Opportunity (EEO), diversity and inclusion, and conflict management training.
Assisted over 126,900 Veterans in skills translation and resume writing
through the VA4Vets Web site.
Hired over 2,290 Veterans at VA, with ired Veterans hired under noncompetitive appointments achieved in under 29 calendar days on average.
Provided employment assistance to 43,929 Veterans by:
Conducting over 119 employment preparation presentations.
Participating in over 94 Veteran Career Events, reaching more than 24,790
Veterans.
Officially partnered with 12 Federal agencies through resource agreements to
utilize VAs services developed through HCIP funding to facilitate Veteran hiring
across the Federal Government.
Provided human resource (HR) training opportunities to over 4,700 VA H.R.
professionals, which improved support to those who directly serve our Veterans.
Delivered virtual H.R. professional training curriculum with 1,688 training instances to close competency gaps.
Provided career guidance through the MyCareer@VA portal to over 200,000 VA
employees.
Responded to 2,458 calls from VA employees through the Resolution Support
Center and resolved 1,598 of their complaints and issues at the earliest opportunity,
enhancing job satisfaction and diverting them from more costly avenues of redress.
Sponsored 400 student interns from diverse and minority serving institutions
and anticipates sponsoring an additional 155 interns in fiscal year (FY) 2014 to
build a diverse qualified pipeline for VA employment.
Supported over 2,100 accommodations for employees with disabilities through
VAs Centralized Reasonable Accommodations Fund since its inception, and projects
funding approximately $500,000 in accommodations in FY 2014.
Funded the hiring of nearly 100 students and employees with disabilities under
term or permanent appointments through VAs Centralized Workforce Recruitment
Program, in support of Executive Orders supporting the employment of individuals
with disabilities and disabled Veterans. As a result of this and other related initiatives, VA has one of the highest representations of individuals with targeted disabilities in all of Federal Government (over 2 percent).
Implemented diversity and inclusion programs that have resulted in the increase of VAs Workforce Diversity Index for the last 4 years, and the decrease of
per capita informal EEO complaints from 1.39 to 1.26 percent, and formal complaints from 0.73 percent to 0.61 percent since FY 2012.
B. With the funding requested for fiscal year 2015, what measureable outcomes
would be expected during that year?
Response. In FY 2015, the measurable outcomes that would be expected through
use of the total obligational authority provided from budget authority, HCIP and
other reimbursables are:
Improved acquisition of diverse, high-performing, fully engaged VA employees
delivering excellent service to Veterans.
Improved retention of diverse and high-performing employees.
Increased survey indicators of a fully engaged workforce.
Improved H.R. services by developing and certifying H.R. professionals to succeed in a dynamic environment.
Improved reintegration for VAs deployable Reserve Component Servicemember
employees.
An increase in the number, diversity, and gender representation of Veteran employees at VA.
Improved responses to customer satisfaction survey for direct Veteran services.
An increase in the accommodation and number of disabled Veteran employees.
Strengthened management of workers compensation claims to reduce costs by
returning employees with work capacity back to work.
Improved employee perceptions of safety programs through Department-wide
surveys and training programs.
Question 70. According to the fiscal year 2015 budget request, the Office of
Human Resources and Administration (HR&A) requests $198 million for Other
Services for fiscal year 2015. Please provide an itemized list of how those funds
would be used. To the extent any of these funds will be spent on contracts, please
explain the nature of the contract and the expected outcomes.
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Response. In addition to the ongoing initiatives provided throughHCIP, HRA requests funding in Other Services for Office of Resolution Management (ORM), Office
of Administration, and Office of Human Resources Management (OHRM). The specific amounts for contracts aligned to these respective services are identified below.
HCIP funding of $161 million includes initiatives such as: leadership and managerial training; the career portal, MyCareer@VA; the skills translator and resume
builder, VA for VETS; the Human Resource Academy; the Senior Executive Service
Collaborative Web site and Performance Management; the National Diversity Internship Program; the Reasonable Accommodation Program; and Conflict Management Training. Continued training investment in these areas is necessary to improve service to our Nations Veterans and their families through a more effective
and engaged VA workforce.
ORM contracts include: Alternative Dispute Resolution Mediations; conflict management training; development and maintenance of info tech equipment; and temporary services for a visually impaired employee.
OHRM funding includes: the Child Care Subsidy Program (CCSP). CCSP is a nationwide program that assists lower income VA employees whose total family income is less than $59,999 per year with the cost of child care. Eligible employees
receive a subsidy based on their total family income. Over 2,000 VA employees have
applied to participate in the program and new applications are received daily.
Additionally, funding is provided for the next generation human resource information system, HRSmart. HRSmart is a state-of-the-art human resource solution to
VAs personnel management and pay challenges. The new HRSmart will replace
VAs 51-year-old-legacy system and will provide the following H.R. functions:
1) Personnel action processing, to include an entry-on-duty solution; 2) Benefits
management; and 3) Compensation management, to include an interface to the Defense Finance and Accounting Service (DFAS) for payroll services. The new system
will also interface with other internal and external systems, such as VAs electronic
official personnel Folder (eOPF), VAs Time and Attendance System, and the Office
of Personnel Managements USA Staffing System.
A breakdown of current estimated FY 2015 contract costs of $198 million follows:
Current Estimated FY 2015 Contract Costs

Cost
(in Millions)
Office
Contract Description
HCIP
Training and Transformation Initiatives
ORM (EEO complaint processing)
Contracts for Investigation of EEO complaints,

Court Transcription Services
$9
Administration
Contracts with Other Government Agencies for Mailroom

Operations, Employee Health Unit/Employee Fitness Center, Transit
Benefits, and Records Storage/Management, etc.
$7
OHRM
Child Care Subsidies; HRSmart
$21
Total
$161
$198
Question 71. According to the fiscal year 2015 budget request, the Office of
Human Resources and Administration plans to spend $11.2 million on travel during
fiscal year 2014 and requests $10.8 million for travel during fiscal year 2015.
A. In total, how many employees are expected to travel during fiscal year 2014,
how many unique travel trips are expected to occur, and what is the expected average cost per expected trip?
Response. Please see the response to question 71B.
B. For fiscal year 2015, how many unique travel trips is the $10.8 million expected to support?
Response. The travel budget identified in the HRA chapter of the budget request
is primarily for travel provided for HCIP. The current 2014 estimates for travel
have been reduced from what was submitted in the original budget request last
year.
HCIP allocates most of its travel funds for training programs conducted by the
VA Learning University (VALU). VALU provides training on a corporate level in the
areas of leadership development, competency improvement, and technical training.
These training courses are provided to all VA employees, not just HRA employees.
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VALU, through its HCIP funding, covers the cost not only of the training but all
travel costs associated with attendance at the training. Travel associated with
HCIP-funded, VALU-sponsored training is tracked separately in the travel management system from all other HRA travel and therefore is listed separately from other
HRA travel in the tables below.
Other travel not associated with HCIP, but included in the HRA budget is for
ORM, which handles the processing of discrimination allegations and conflict resolution for both field and VA Central Office EEO-related cases. HRA travel funds also
provide reimbursements to other VA offices for travel incurred for attendance at
training sessions associated with new union contracts as well as travel associated
with normal HRA business.
($ in millions)
HRA Travel Costs
FY 2014
FY 2015
VALU-sponsored travel .............................................................................................................................

All other HRA travel not included in VALU totals ...................................................................................
$8.5
$1.4
$9.4
$1.4
Total ................................................................................................................................................
$9.9
$10.8
Number of Trips
FY 2014
FY 2015

All other HR&A travel not included in VALU totals ................................................................................
5,363
910
5,900
918
Total ................................................................................................................................................
6,273
6,818
(whole $)
Average Cost of Trip
FY 2014
FY 2015

All other HRA travel not included in VALU totals ...................................................................................
$1,585
$1,540
$1,593
$1,540
Total ................................................................................................................................................
$1,578
$1,584
Question 72. The Corporate Senior Executive Management Office (CSEMO), within the Office of Human Resources and Administration, was created to provide a
centralized approach to the executive life cycle management. Under its responsibilities, CSEMO has created two training programsSenior Executive Leadership Development Course I (SLC I) and Senior Executive Leadership Development Course
II (SLC II). According to the budget request, CSEMO is developing a third developmental training program referred to as SLC III.
A. Please provide the Committee with a detailed description of the SLC III course,
including curriculum, cost estimate (travel, facility rentals, course material, etc.)
and when the course will be available to VA senior executives.
Response. CSEMO is considering SLC III as a follow-on course for senior executives who have completed SLC I and II. VA is presently in the concept pre-design
phase of future SLC courses and does not have such information.
B. For each training program (SLC I, SLC II, and SLC III), please provide the
amount VA expects to spend in fiscal year 2015.
Response. VA projects holding 23 cohorts (sessions) of SLC I and II in 2015,
based on the volume of new senior executive hires through the end of FY 2014 and
into FY 2015. For SLC I and II, the estimated cost per cohort is based on the average cost of previous year cohorts with an added 5 percent, assuming the program
content and cohort size remain about the same.
Course
# Cohorts
Estimated cost
SLC I ......................................................
SLC II .....................................................
2
3
$179,096
$506,066
Total ..............................................
$685,162
VA will be able to provide SLC III cost estimates after the design is completed.
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C. How much was spent on each training course (SLC I, SLC II, and SLC III)
for fiscal year 2009 through fiscal year 2014? Please breakdown by fiscal year, by
category of spending (travel, facility rentals, course material, etc.), and by training
program.
Response.
SLC I: There were two cohorts of SLC I, a training course for newly appointed
senior executives, in late FY 2012 (SLC I was initiated in 2012).
SLC I
Dates
Program Costs
Cohort 1 .............
Cohort 2 .............
July 22-27, 2012 .............................................................

Aug 25-31, 2012 ............................................................
$58,728
$53,464
Travel
$32,938
$25,436
Total
$91,666
$78,900
* There were no SLC I cohorts held in FY 2013.
SLC II: This course on strategic thinking and leading change began in FY 2011.
SLC II
Cohorts
Program Costs
OPM Fee
FY 2011 ..............
FY 2012 ..............
FY 2013 ..............
Cohorts 1 - 3 .......................................
Cohorts 4 - 16 .....................................
Cohorts 17 - 19 ...................................
$528,986
$2,535,946
$428,367
$23,804
$95,098
$16,063
Travel
Total
$49,777
$273,391
$39,441
$602,567
$2,904,435
$483,871
Question 73. The Veteran Employment Services Office (VESO) was established by
VA HR&A to comply with Executive Order 13518. Please provide a detailed budget
for VESO, including the number of FTE, requested appropriations, and the amount
projected to be spent on all VESO initiatives including VA for Vets.
Response. VESO is funded through reimbursements received from HCIP. VESO
has 49 full-time equivalent employees. The detailed budget estimates for VESO and
the VA for Vets initiative for FYs 2014 and 2015 are included below:
Initiative Name
2014 Cost
2015 Cost
Subtotal Personnel Compensation ...............................................................................................

Subtotal Regular Benefits ...........................................................................................................
4,275,296
1,206,096
4,318,049
1,218,157
Total Pay .............................................................................................................................
5,481,392
5,536,206
VA for Vets Web Site and Helpdesk ............................................................................................
8,437,625
8,690,754
Total Initiative ....................................................................................................................
8,437,625
8,690,754
Travel ...........................................................................................................................................
Transportation of Things .............................................................................................................
Printing & Reproduction ..............................................................................................................
Training ........................................................................................................................................
Other Services ..............................................................................................................................
Supplies & Materials ...................................................................................................................
301,000
3,000
75,000
70,000
411,298
28,000
306,117
3,051
76,275
71,190
418,290
12,250
Total Non-Pay (Including Initiative) ...................................................................................
9,325,923
9,577,927
Total Cost ..................................................................................................................
$14,807,315
$15,114,133
Office of Policy and Planning

Question 74. The fiscal year 2015 budget request includes $27 million to be spent
on Other Services by the Office of Policy and Planning. Please provide a specific
itemized list of how these funds would be spent. To the extent any of these funds
will be spent on contracts, please explain the nature of the contract and the expected outcomes.
Response. Of the $27 million to be spent on other services by OPP, $19.3 million
is from reimbursement from customer offices for servies provided, supplementing
$7.8 million from budget authority. Descriptions of work and expected outcomes are
as follows:
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Estimated $
Amount for
Contract
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Description of Work Performed
Expected Outcomes
$1,800,000
Support the enterprise Program Management Office (ePMO)

in the expansion and operation of the Program Management Center of Excellence (PMCOE) to further develop and
promulgate program management standards, doctrine,
and policy. The PMCOE addresses all disciplines of program management including general program management, requirements, cost estimation, acquisition strategy,
systems engineering, enterprise architecture, test and
evaluation, and construction management. Further, the
PMCOE supports the institutionalization of the Departments acquisition program management framework and
supports the development of a subordinate end-to-end requirements gathering, prioritization, and approval process.
Establish an integrated requirements development framework, enabled by a

world-class program management capability, which aligns project plans and
outcomes to Department goals and objectives to improve services to Veterans.
$1,100,000
Provide support to ePMOs oversight of the planning and

execution of key programs within VAs benefits, health,
and corporate portfolios to ensure effective oversight, integration, and sustainment of new capabilities into the
routine operations of the Department.
Enable performance monitoring and support resolution of risks within VAs

highest priority programs to increase
opportunities for program success to
improve services that benefit Veterans.
$500,000
Assist ePMO in executing the Secretarys Carey Performance

Excellence Program by training personnel to understand
the Baldrige criteria to develop application packages,
provide support to examiners during consensus week, provide technical editing support, and provide feedback reports to applicants for continuous improvement purposes.
Quality feedback reports for applicants

used to continuously improve management systems and service to Veterans.
$600,000
Provide the Office of Interagency Collaboration and Integration project management support, technical support, performance measurement, and process improvements/business process reengineering support for the implementation and oversight of the IDES.
Ensure IDES meets program goals and

continues to improve the delivery of
seamless, cost-effective quality services to transitioning Veterans.
$1,500,000
Support the Office of Corporate Analysis and Evaluation

(CAE) in maturing the multi-year planning, programming,
budgeting, and execution (PPBE) framework established
to optimally align VA services with 21st century Veterans
needs. The work will aid VAs multi-year programming
process and conduct independent analysis/review, corporate studies and analysis, and other PPBE activities
across VA.
Establish programming excellence and

data-driven analytical capabilities that
inform effective strategic resource allocation and stewardship of VA resources
to effectively serve Veterans.
$500,000
Automation of CAEs requirements development system,

which currently uses spreadsheets and other flat files
to perform the complex tasks of annual programming including:
Automated input functions for capability requirements
proposals and special interest analysis;
Ability to save all input data in a relational database
(RDB); and
Easy data-downloads from RDB to standard Microsoft
tools.
Streamline and automate programming

capability to allow more efficient and
effective analytical capabilities that inform effective strategic resource allocation and stewardship of VA resources.
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Estimated $
Amount for
Contract
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Expected Outcomes
$950,000
Assist the Office of Policy in:

Supporting internal business process and VAs governance
process;
Executing strategic studies environmental scanning and
analysis processes to identify long-range issues and drive
innovation and transformation;
Executing VAs quadrennial strategic planning process focused on strategic outcomes that influence policies, programs and resources; and
Executing VAs policy analysis process that is proactive,
externally engaged, and internally aligned.
Enable better strategic decision making

among VA senior leaders regarding
services to Veterans and management
of the Department.
$16,091,000
Support VA in developing Customer Data Integration (CDI),

establishing enterprise accountability and the integration
of processes and systems to support an integrated, Veteran-centric authoritative view of VAs customers and
their needs.
Provision of the most appropriate, effective and efficient service possible while
reducing burden on Veterans and improving delivery of VA services and
benefits.
$380,000
Assist the Office of Data Governance and Analysis (DGA) in

the expansion and support of the U.S. Veteran Eligibility
Trends and Statistics (USVETS) multidimensional database and analysis system; provide statistical application
system (SAS) programming support for the National Center for Veterans Analysis and Statistics.
Provide an integrated view of Veteran

users and non-users of VA benefits or
services, as well as statistical analysis
and reports on Veterans to support VA
planning, policy development, and decision making.
$370,000
Provide DGA with global information systems (GIS) analysis

to:
Provide technical and professional GIS services to supplement staffs efforts by compiling, creating, and modifying
GIS layers and related tools;
Enhance DGAs integrated Web-based mapping capability
with analysis system datasets and fully integrate the
geospatial analysis dashboard (GAD) and geospatial
analysis tools (GAT) into the analysis system and intranet
portal; and
Develop interactive web applications and display interactive maps presenting data on Veteran population and
VA programs.
Enhance GIS platform and integration of

SAS and GIS technologies which improve Veteran data dissemination and
data analysis by deploying new mapping capabilities in the ArcGIS intranet
and internet portal.
$859,000
Support the Office of the Actuary by using cutting edge

analytic tools to develop predictive models that predict
future demand, utilization, and cost for various VA benefit programs and health care services.
Provide models to predict Veterans demands and use of VA products and

services, and identify key metrics to
support VA policy analysis and strategic planning process, enabling VA to
identify and strategically target its resources to better serve Veterans.
$750,000
Develop training, guidance, and other materials for DGA to:

Support enterprise-wide implementation of advanced data
governance concepts and practices;
Further develop the concepts in VAs data governance
training program; and
Provide program support to the data governance activities
and CDI efforts.
Improve the Departments data governance maturity, improving management

and governance of data for quality improvement.
$1,300,000
Acquire Veteran demographics and socio-economic data

from commercial data sources for DGA to supplement existing VA data sources.
The integrated data will enable a more

complete view of Veteran users and
non-users of VA benefits or services for
enhanced statistical analyses, outreach, and modeling.
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Estimated $
Amount for
Contract
Expected Outcomes
$200,000
Provide DGA with a special supplement to the current population survey on Veterans on such topics as demographics, VA status, VA health, education, etc. This is a
critical survey to capture Veteran employment statistics.
Better understanding of Veteran employment challenges to alleviate Veteran

unemployment.
$215,000
Policy analysis conducted on new legislation and emerging

needs of Veterans.
Robust analysis to inform the Department

on future Veteran requirements.
$130,000
Supports Departmental franchise activities, such as security

clearances and payroll processing.
N/A
Question 75. For fiscal year 2015, the budget request includes over $25 million
for the Office of Policy and Planning and would support 116 employees. For each
office within the Office of Policy and Planning, please identify the positions and paygrades for employees that would be assigned to that office during fiscal year 2014
and fiscal year 2015 and the number of contractors that are expected to be assigned
to each such office.
Response.
2014
Title
Office of the Assistant Secretary

Assistant Secretary ......................................................................................................
Executive Assistant to the Assistant Secretary ..........................................................
Scheduler/Program Support to Assistant Secretary ....................................................
Principal Deputy Assistant Secretary ..........................................................................
Scheduler/Program Support to Principal Deputy Assistant Secretary ........................
Senior Policy Advisor ...................................................................................................
Operations
Director of Operations .................................................................................................
Human Capital Manager .............................................................................................
Administrative Officer ..................................................................................................
Communications Specialist .........................................................................................
Budget Officer .............................................................................................................
Series
Grade
301
301
301
301
301
343
ES
GS 15
GS 11
SES
GS 11
GS 15
343
301
301
343
343
GS 15
GS 14
GS 13
GS 9
GS 13
Office of Interagency Collaboration and Integration

Executive Director ........................................................................................................
301
Scheduler/Program Support .........................................................................................
301
Integrated Disability Evaluation System Service (IDES)
Director IDES ................................................................................................................
301
Management Analyst ...................................................................................................
343
343
343
Joint Executive Council/Senior Oversight Committee Service (JEC/SOC)
Director JEC/SOC ..........................................................................................................
301
Special Assistant .........................................................................................................
301
343
343
343
343
343
343
Corporate Analysis and Evaluation Service
Programming Service
Director ........................................................................................................................
Budget Analyst ............................................................................................................
Operations Research Analyst .......................................................................................
Budget Analyst ............................................................................................................
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343
343
560
1515
560
1515
SES
GS 11
GS
GS
GS
GS
15
14
14
11
GS 15
GS 15
GS 14
GS 9/11
GS 14
GS 14
GS 11
GS 9
SES
GS
GS
GS
GS
GS
15
14
14
14
14
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90
2014Continued
Title
Series
Grade

Program Analyst ..........................................................................................................
Program Analyst ..........................................................................................................
Analysis & Evaluation Service
Director ........................................................................................................................
343
343
343
GS 14
GS 13/14
GS 13/14
343
1515
1515
1515
343
1515
1515
GS 15
GS 14
GS 14
GS 14
GS 13
GS14
GS 14
343
301
SES
GS 9
343
343
343
343
343
399
301
GS 15
GS 14
GS 11
GS 13
GS 9/11
GS 13
GS 9
Office of Policy
Deputy Assistant Secretary ..........................................................................................
Program Support ..........................................................................................................
Policy Analysis Service
Director ........................................................................................................................
Strategic Studies Group
Director ........................................................................................................................
Strategic Planning Service
Director ........................................................................................................................
Office of Data Governance and Analysis
Deputy Assistant Secretary ..........................................................................................
National Center for Veterans Analysis and Statistics
Program Support ..........................................................................................................
Analysis and Statistics Service
Director ........................................................................................................................
Statistician ..................................................................................................................
Statistician ..................................................................................................................
Statistician ..................................................................................................................
Statistician ..................................................................................................................
Statistician ..................................................................................................................
Reports and Information Service
Director ........................................................................................................................
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343
343
343
343
343
GS
GS
GS
GS
GS
15
14
14
12
11
343
343
343
343
343
343
343
GS
GS
GS
GS
GS
GS
GS
15
14
14
14
13
11
11
343
SES
301
301
SES
GS 11
1530
1530
343
343
343
1530
1530
343
343
GS
GS
GS
GS
GS
GS
GS
GS
GS
343
343
343
343
343
343
343
343
GS 15
GS 14
GS 14
GS 14
GS 14
GS 12
GS 9
GS 14
15
14
14
13
14
14
14
13
13
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2014Continued
Title
Series
Grade

Office of the Actuary
Chief Actuary ...............................................................................................................
Deputy Chief Actuary ...................................................................................................
Actuary .........................................................................................................................
Economist ....................................................................................................................
Actuary .........................................................................................................................
Actuary .........................................................................................................................
Actuary .........................................................................................................................
343
343
GS 12
GS 12
1510
1510
1510
110
1510
1510
1510
343
SL
GS 15
GS 14
GS 14
GS 14
GS 14
GS 14
GS 14
301
343
301
301
SES
GS 11
GS 15
SES
343
343
343
343
343
343
343
343
GS
GS
GS
GS
GS
GS
GS
GS
343
343
343
343
343
343
343
343
GS 15
GS 11
GS 13
GS 14
GS 9
GS 14
GS 14
GS 14
343
343
343
343
GS
GS
GS
GS
Enterprise Program Management Office

Deputy Director ............................................................................................................
Executive Program Manager ........................................................................................
Program Management Policy Service
Director ........................................................................................................................
Operational Management Review
Director ........................................................................................................................
Resource Management Service
Director ........................................................................................................................
15
14
14
14
13
14
14
14
15
14
14
13
Additionally, OPP has contracts in place with third parties that involve their employees working in VA facilities. However, VA does not control those companies
independent business decisions regarding staffing requirements. Thus, VA is unable
to give a number of contractor employees assigned to OPP.
Office of Operations, Security, and Preparedness
Question 76. For fiscal year 2015, the Office of Operations, Security, and Preparedness requests total resources of $31.3 million and 133 employees. Please provide a list of the positions that would be filled with that funding and the pay-grades
for those positions.
Response. The Office of Operations, Security, and Preparedness (OSP) request
consists of $17.9 million in budget authority and $13.4 million in reimbursable authority for a total of $31.3 million in FY 2015 budget. The personnel services portion
of that request is $17.6 million to support 133 full-time employee equivalents.
Grade
Title
Organization
Position
OSP Front Office

Honorable
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Grade
GS-12
Title
Organization
Position
Special Assistant to A/S
OSP
Staff Assistant
Office of Resource Management (ORM)

GS-15
GS-13
GS-12
GS-14
GS-14
GS-12
GS-14
Director, Resource Mngt.

Staff Assistant to Director
Program Analyst
Budget Analyst
Administrative Officer
Staff Assistant
Resource Manager
Resource
Resource
Resource
Resource
Resource
Resource
Resource
Management
Management
Management
Management
Management
Management
Management
Director, ORM
Staff Assistant
Program Analyst
Budget Officer
Admin Officer
Admin Officer
Management Analyst
Office of Emergency Management (OEM)

SES
GS-14
GS-11
GS-12/13
Deputy Assistant Secretary OEM

Senior Staff Assistant
Staff Assistant
Management Analyst (Public Health)
Emergency Management
VACANT
DAS OEM
Support
Support
Support
Planning, Exercise, Training, and Evaluation Service (PETE)

GS-15
DirEmergency Management Spec.
OEM/PETE
Director PETE
Planning
GS-14
GS-11/12/13
GS-13
Lead Emergency Mgt. Spec.

Emergency Management Spec. (Planner/Liaison Officer (LNO))
Program AnalystGeographic Information
System (GIS)
OEM/PETE
OEM/PETE
Planning
Planning
OEM/PETE
Planning
Intern
OEM/PETE
Planning
GS-11/12/13
GS-9/11/12
GS-11/12/13
Emergency Management Spec.(DHS LNO)

Program AnalystGIS
Management Analyst (Planner/LNO)
OEM/PETE
OEM/PETE
OEM/PETE
Planning
Planning
Planning
Exercise, Training, and Evaluation

GS-14
GS-11/12/13
GS-12/13
GS-12/13
GS-12/13
Team Lead/Exercises
Spec.
Spec.
Spec.
Spec.
(Exercise)
(Continuity)
(Training)
(Evaluator)
OEM/PETE
OEM/PETE
OEM/PETE
OEM/PETE
OEM/PETE
Planning
Planning
Planning
Planning
Planning
VA Integrated Operations Center (IOC)

GS-15
GS-14
GS-13
GS-9/11/12
GS-9/11/12
GS-9/11/12
GS-9/11/12
GS-9/11/12
GS-9/11/12
GS-9/11/12
GS-9/11/12
GS-12/13
GS-12/13
GS-12/13
GS-12/13
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Director/(Supv.) VA IOC (FY 12)

(Supv.) Readiness Operation Spec
Readiness Operation Spec. (Team Lead)
Readiness Operation Spec.
Program Analyst
Program Analyst
Program Analyst
Readiness Operations Specialist (National
Operations Center Liaison)
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OEM
OEM
OEM
OEM
OEM
OEM
OEM
OEM
OEM
OEM
OEM
OEM
OEM
OEM
Sfmt 6621
IOC
IOC
IOC
IOC
IOC
IOC
IOC
IOC
IOC
IOC
IOC
IOC
IOC
IOC
IOC
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Grade
Title
Organization
Position
Operations & National Security

GS-15
GS-14
Director (Readiness Op. Spec.)

Emergency Management Spec.
OEM
OEM
COOP/COG
National Security
Operations
GS-14
GS-13
GS-11
GS-9/11/12
GS-9/11/12
GS-12
Readiness
Readiness
for Site
Readiness
Readiness
Readiness
Readiness
Operation Spec. (Site B Director)

Operation Spec. (Deputy Director
B)
Operation Spec.
Operations Spec.
Operations Spec.
Operation Spec. (Director Site C)
OEM
OEM
COOP/COG
COOP/COG
OEM
OEM
OEM
OEM
COOP/COG
COOP/COG
COOP/COG
COOP/COG
National Security Service

GS-14
GS-13
GS-13
GS-13
Special
Special
Special
Special
Security
Security
Security
Security
Officer
Representative
Representative
Representative (ROS)
OEM
OEM
OEM
OEM
National Security
National Security
National Security
COOP/COG
Personnel Security & Identity Management (PSIM)

SES
GS-12
GS-15
GS-14
GS-13
GS-13
GS-11
GS-343-11
GS-7
GS-7
GS-7
GS-7
GS-7
GS-7
GS-15
GS-14
GS-12/13
GS-12/13
GS-12
GS-12
GS-11
Director, Personnel Security and Identity

Management
Staff Assistant to Director
Director, HSPD-12
Deputy Director, Homeland Security
Presidental Directive (HSPD)-12
Physical Security Specialist
Program Analyst
Director, Personnel Identification Verification
(PIV) Office
Program Analyst
Program Specialist
Program Specialist
Program Specialist
Program Specialist
Program Specialist
Program Specialist
Director, Personnel Security and Suitability
(PSS)
Acting Director/Deputy Director, PSS
Security Specialist
Security Specialist
Security Specialist
Security Specialist
Security Specialist
PSIM
PSIM
PSIM
PSIM
PSIM
PSIM
HSPD-12
HSPD-12
PSIM
PSIM
PSIM
HSPD-12
HSPD-12
HSPD-12
PSIM
PSIM
PSIM
PSIM
PSIM
PSIM
PSIM
PSIM
HSPD-12
PIV Office
PIV Office
PIV Office
PIV Office
PIV Office
PIV Office
PSS
PSIM
PSIM
PSIM
PSIM
PSIM
PSIM
PSS
PSS
PSS
PSS
PSS
PSS
Identity, Credentials, and Access Management (ICAM)

GS-15
GS-11
GS-14
GS-12
GS-14
Director, ICAM
Staff Assistant
Staff Assistant
Program Analyst
ICAM
ICAM
ICAM
ICAM
ICAM
ICAM
ICAM
ICAM
ICAM
ICAM
Identity Management (Identity Mgt.)

GS-14
GS-11
GS-14
GS-14
GS-11/12/13
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Staff Assistant
Program Analyst
Program Analyst
Program Analyst
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Identity
Identity
Identity
Identity
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Mgt.
Mgt.
Mgt.
Mgt.
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Identity
Identity
Identity
Identity
Mgt.
Mgt.
Mgt.
Mgt.
Mgt.
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Grade
GS-11/12/13
GS-7/9/11
GS-7/9/11
Title
Organization
Position
Program Analyst
Program Support
Program Support
Identity Mgt.
Identity Mgt.
Identity Mgt.
Identity Mgt.
Identity Mgt.
Identity Mgt.
Access Management
GS-14
GS-11
GS-14
GS-14
GS-11/12/13
GS-11/12/13
GS-7/9/11
GS-7/9/11
DirectorAccess Management
Staff Assistant
Program Analyst
Program Analyst
Program Analyst
Program Analyst
Program Support
Program Support
Access
Access
Access
Access
Access
Access
Access
Access
Mgt.
Mgt.
Mgt.
Mgt.
Mgt.
Mgt.
Mgt.
Mgt.
Access
Access
Access
Access
Access
Access
Access
Access
Mgt.
Mgt.
Mgt.
Mgt.
Mgt.
Mgt.
Mgt.
Mgt.
On-Board/Monitor/Off Board
GS-14
GS-11
GS-14
GS-11/12/13
GS-7/9/11
Director-On-Board/Off-Board
Staff Assistant
Program Analyst
Program Analyst
Program Support
On-Board/Off-Board
On-Board/Off-Board
On-Board/Off-Board
On-Board/Off-Board
On-Board/Off-Board
On-Board/Off-Board
On-Board/Off-Board
On-Board/Off-Board
On-Board/Off-Board
On-Board/Off-Board
Office of Security & Law Enforcement (OSLE)

SES
GS-13
GS-13
GS-11
GS-15
GS-07
Director for OSLE

Program Analyst
Staff Assistant
Director, Police Service
Program Support Assistant
OSLE
OSLE
OSLE
OSLE
OSLE
OSLE
OSLE Lead
Operations
Operations
Operations
Police Lead
Operations
LEO/Investigations
GS-14
GS-13
GS-13
GS-13
GS-13
GS-12/13
Chief
Criminal
Criminal
Criminal
Criminal
Criminal
Investigator
Investigator (Watch officer)
Investigator
Investigator
Investigator
Oversight
Oversight
Oversight
Oversight
Oversight
Oversight
&
&
&
&
&
&
Investigations
Investigations
Investigations
Investigations
Investigations
Investigations
Lead
Crim
Crim
Crim
Crim
Crim
Inv.
Inv.
Inv.
Inv.
Inv.
Lead
Crim
Crim
Crim
Crim
Inv.
Inv.
Inv.
Inv.
Intelligence & Crime Analysis

GS-14
GS-12/13
GS-13
GS-13
GS-12/13
Chief
Criminal
Criminal
Criminal
Criminal

Investigator
Intell
Intell
Intell
Intell
Intell
&
&
&
&
&
Crime
Crime
Crime
Crime
Crime
Analysis
Analysis
Analysis
Analysis
Analysis
Executive Protection (EX Pro)

GS-14
GS-13
GS-13
GS-13
GS-11
GS-13
GS-13
GS-12
GS-12
GS-12
GS-12
WL-9
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Criminal Investigator
Security Specialist
Security Specialist
Motor Vehicle Operator
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Executive
Executive
Executive
Executive
Executive
Executive
Executive
Executive
Executive
Executive
Executive
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Protection
Protection
Protection
Protection
Protection
Protection
Protection
Protection
Protection
Protection
Protection
Protection
Lead
EX Pro
EX Pro
EX Pro
EX Pro
EX Pro
EX Pro
Security
Security
EX Pro
EX Pro
EX Pro
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Grade
Title
Organization
Position
Infrastructure Security & Policy

GS-14
GS-13
GS-12
GS-12/13
Chief
Security Specialist
Security Specialist
Policy
Policy
Policy
Policy
&
&
&
&
Infrastructure
Infrastructure
Infrastructure
Infrastructure
Protection
Protection
Protection
Protection
Lead
Security
Security
EX Pro
Question 77. For fiscal year 2015, the Office of Operations, Security, and Preparedness requests $10.3 million for Other Services. Please provide a specific
itemized list of how these funds would be spent. To the extent any of these funds
will be spent on contracts, please explain the nature of the contract and the expected outcomes.
Response. OSP uses contract support in the following areas: Department of Homeland Security/Federal Protective Service Contract Guards for General Service Administration leased spaces in the Capital Region ($3.0 million); and Program support for the HSPD12 program management office ($3.0 million). The new ICAM/
On-Boarding and Off-Boarding Program uses contract Program Management support ($3.0 million). OSP also pays for support for Continuity of Operations sites and
Continuity of Government sites, which are located outside of the National Capital
Region ($750,000). OSP also has internal VA Service Level Agreements totaling
$525,000 and some small maintenance contracts.
Office of Public and Intergovernmental Affairs
Question 78. For fiscal year 2015, the Office of Public and Intergovernmental Affairs requests total resources of $22.8 million and 90 employees. Please provide a
list of the positions that would be filled with that funding and the pay-grades for
those positions.
Response.
GRADE
# POSITIONS
SES/EX
Assistant Secretary, Office of Public and Intergovernmental Affairs; Executive Director; Director
Intergovernmental Affairs; Director Public Affairs; Deputy Assistant Secretary Intergovernmental Affairs
15
16
Executive Assistant; Special Assistant; Program Management; Public Affairs Specialist; Program Specialist; Deputy Director Homeless Veterans Initiative Office; Director of Media Relations; Speechwriter
14
27
Public Affairs Specialist; Program Specialist; Staff Assistant; Program Analyst; Management
Analyst
13
15
Budget Analyst; Program Specialist; Public Affairs Specialist; Program Specialist
12
Staff Assistant; Special Assistant; Program Analyst; Program Specialist
11
12
Public Affairs Specialist; Staff Assistant
10
Program Specialist; Program Support Assistant; Public Affairs Specialist; Student Trainee
VA indicated that the Office of Public and Intergovernmental Affairs employs at
least four speechwriters, paid at the GS15 level.
A. In total, how much funding is requested for fiscal year 2015 for speechwriters
for this office?
Response. For fiscal year (FY) 2015, the Office of Public and Intergovernmental
Affairs (OPIA) requests $555,370 for three speechwriters.
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B. On average, how many speeches do these individuals write per year and for
which VA officials are they drafting speeches?
Response. Currently, there are three OPIA speechwriters, though there are four
billetsthe fourth position was added in 2008 in anticipation of expected retirements, to ensure continuity in senior leaders communications; there are currently
no plans to fill the fourth position. The three speechwriters directly support the Secretary, Deputy Secretary, and Chief of Staff of the Department of Veterans Affairs.
As required, they may also provide expertise, editing, fact checking, and review of
products written for Undersecretaries, Assistant Secretaries, and other VA executives.
Duties of the three speechwriters in support of the three principals extend well
beyond writing speeches and include composing, refining, and revising Congressional testimony; composing select correspondence; conducting current and historical
research for a variety of written products, drafting articles on behalf of senior leaders for various publications; writing Department messages on behalf of senior leaders; composing scripts for senior leaders videotaped remarks; editing products pertinent to the Office of the Secretary composed by other offices; reviewing and providing input for White House and other government agencies documents involving
Veterans; and occasional travel to support the Secretary at major speaking events.
Each of the three speechwriters works on estimated 225250 products annually.
Question 80. Responses to questions about the fiscal year 2014 budget request indicate that public affairs personnel from the Office of Public and Intergovernmental
Affairs are located in New York, Atlanta, Chicago, Denver, Los Angeles, and Dallas.
A. Please identify the locations of the offices for public affairs personnel located
outside of Washington, DC. For example, are they co-located with VA medical centers or regional offices?
Response.
New YorkLocated with the New York Veterans Benefits Administration
(VBA) Regional Office
Washington, DCLocated in VBA Business Office
AtlantaLocated in Atlanta VBA building
ChicagoLocated in Chicago VBA Regional Office
DenverLocated in Denver VBA Regional Office
Los AngelesLocated on Greater Los Angeles Medical Center campus
DallasLocated with Veterans Integrated Service Network (VISN) 17 offices
B. Please provide a description of the responsibilities and performance metrics for
personnel located at these public affairs regional offices.
Response.
Responsibilities:
Manage Office of Public Affairs (OPA) regional office in accordance with Department policy. Efficiently organize staff workload, establish deadlines, and ensure
achievement of quality standards. Recommend appropriate training and career-development activities, submit nominations for performance awards.
Maintain appropriate liaison with Administrations, VISNs, and facility staffs.
Monitor professional development of public affairs officers at the regional and facility levels, assist by informal coaching and formal training.
Respond to queries from the news media in a timely manner. Make referrals
in accordance with OPA and department policy.
Initiate contacts with the news media and generates news media interest in VA
programs, officials and events.
Advise facilities, regional leadership and senior departmental leadership on the
media relations aspect of issues. Stay informed of topics of Department-wide interest in addition to local and regional issues.
Develop timely, accurate event memos, briefing papers, read-ahead files and
other information to prepare senior Department leaders during visits to the region.
Accompany senior Department leaders during visits to the region or help in arranging appropriate assistance from other personnel. Maintain the flexibility to assist senior leaders with little or no advance warning.
Assist in the preparation of news releases, fact sheets, media advisories, and
letters to the editor, op-eds, and media pitches, in accordance with the highest professional standards.
Inform in a timely manner facility and regional directors and public affairs officers of Departmental policy affecting various issues.
Maintain regular contact with all facilities and appropriate regional offices
within the region, assist regional and facility public affairs offices on the prepara-
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tion of public affairs products, promote and participate in regional public affairs
councils.
Alert the Director of Media Relations, the Deputy Assistant Secretary for Public
Affairs and the Assistant Secretary for Public and Intergovernmental Affairs, the
press secretaries, other staff members and the chain-of-command of situations involving the news media that may require their attention.
Monitor activities of the news media and advise the press secretaries and Office
of Media Relations director on appropriate VA response.
Make recommendations on media relations plans, crisis communications strategies and promotional campaigns based upon the highest professional standards and
a practical understanding of issues and the workings of the media.
Performance Metrics:
Number of personnel trained; media queries fielded; feedback from senior leaders
on trip support; results of media pitches; assessment of relationships with senior
leaders and associated public affairs officers in their region.
C. For fiscal year 2015, what level of funding is requested to maintain public affairs personnel in locations outside of Washington, DC?
Response. OPA would need the same infrastructure funding as that of FY 2014,
for 22 full-time employees, associated travel and automation needs.
Question 81. For fiscal year 2015, the Office of Public and Intergovernmental Affairs requests $9.5 million for purposes of an adaptive sporting program for veterans
with disabilities. Please provide a breakdown of how those funds are expected to be
expended.
Response. For FY 2015, OPIA requests $9.5 million for purposes of the adaptive
sports grant program and the monthly assistance allowance for disabled Veterans
training in Paralympic sports (Paralympic allowance). During FY 2015, the adaptive
sports grant program is expected to expend $7.5 million through the adaptive sports
grant. With the passage of P.L.11359 in December 2013, VA is transitioning to a
competitive grant program as opposed to awarding grants only to the United States
Olympic Committee as authorized under previous legislation. Since the transition
is still in progress, specific details of FY 2015 fund expenditures cannot be projected
at this time. However, VA fully expects eligible entities to apply for grants up to
$7.5 million to provide adaptive sporting opportunities for disabled Veterans and
disabled members of the Armed Forces. As for the Paralympic allowance, $2.0 million is projected to be expended in Paralympic allowance payments and authorized
expenses.
the Office of Public and Intergovernmental Affairs indicated that it planned to
spend $300,000 in fiscal year 2013 to establish an agency-wide VA History Office
and develop history outreach programs.
A. In total, how much has been expended on these initiatives and how much is
requested for these purposes for fiscal year 2015?
Response. The expended (contract) amount is $209,073 for FY 2014. Currently,
there are no FY 2015 funds programmed for a continuation of this effort.
B. What measurable outcomes does VA expect to achieve as a result of these initiatives?
Response. The ongoing and short-duration FY 2014 effort is intended to assess the
Departments current history and archival programs, and offer recommendations on
what can be done to improve and enhance those existing programs.
Question 83. In the fiscal year 2015 budget request, the Office of Public and Intergovernmental Affairs seeks $495,000 for Other Services. Please provide a breakdown of how those funds would be expended. To the extent any of these funds will
be spent on contracts, please explain the nature of the contract and the expected
outcomes.
Response.
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Printing Services ....
$100,000
Total ..............
$100,000
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Printing of the Veterans benefits handbook; Translation services.
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Contracts/Name
Amount (Est.)
Description
Barbaricum LLC .....
$234,400
Gov-Delivery ...........
$25,000
Misc. Contracts ......
$135,600
To establish, maintain, and distribute a customized executive daily news summary.

Gov. delivery provides an enterprise (Department-wide) customized email service
for users who subscribe/opt in to updates from VA.
Rent, Transit Subsidy, UPS Service, Service Level Agreements, Copier
Maintenances.
Total ..............
$395,000
Question 84. According to the fiscal year 2015 budget request, the Office of Public
and Intergovernmental Affairs requests $344,000 for travel for fiscal year 2015. How
many trips is that level of funding expected to support and what is the average expected cost per trip?
Response. OPIAs request of $344,000 for travel in FY 2015 is expected to support
an estimated 189 trips with an average estimated cost of $1,811. These trips support the OPIA mission including tribal affairs, State Veterans Affairs offices, the
Adaptive Sports Program and employee training.
Question 85. Please provide the Committee data on how much VA spent on outreach activities in fiscal year 2014 and is projected to be spent during fiscal year
2015. The information should include, but is not limited to: 1) the amount in aggregate VA spent enterprise-wide on advertising outreach, 2) a breakdown by administration of the amount spent on outreach, and 3) the categories of spending VA believes encompass all forms of outreach undertaken and the funding breakdowns.
Response.
FY 2014 Advertising and Outreach Spending

Television Ads
Radio Ads
Print Ads
VHA ........................
See **
below
See **
below
See **
below
VBA ........................
See * below
See * below
Social/ Digital
Media
See **
below
Outreach
**VHA does not centrally

track costs associated
with outreach events
$878,068
Total
$21,726,574
$878,068
NCA ........................
$74,325
attendance at outreach
conventions/conferences
$74,325
Center for Faith

Based and
Neighborhood
Partnerships.
$15,576
Travel/Per Diem to attend
outreach activities
$15,576
Center for Minority

Veterans.
$50,837
Travel/Per Diem/Booth
Rentals, participating in
outreach activities
$50,837
Center for Women

Veterans.
$3,000
National Veterans
Outreach.
$2,241,822
$322,402
$1,216,064
$2,000,000
Ad council
$3,000
$5,780,288
*VBA has a FY 2014/2015 contract that includes Public Service Announcement (PSA) development. Airing of radio and TV PSAs are through
donated air time.
**VHA does not centrally track costs associated with outreach events.
**The total VHA advertising dollars spent by program offices, VISNs, and VAMCs (as of 3d qtr) is $21,726,574.
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Projected FY 2015 Advertising and Outreach Spending
Television Ads
Radio Ads
Print Ads
Social/Digital
Media
Outreach
VHA ........................
Total
$27,647,865
VBA ........................
See **
below
See **
below
$912,500
$912,500
NCA ........................
$80,875
attendance at outreach
conventions/conferences
$80,875
Center for Faith

Based and
Neighborhood
Partnerships.
$8,004
Travel/Per Diem to attend
outreach activities
$8,004
Center for Minority

Veterans.
$65,000
Travel/Per Diem/Booth
Rentals, participating in
outreach activities
$65,000
Center for Women

Veterans.
$3,000
participating in outreach
activities
$3,000
National Veterans
Outreach.
See ***
Below
See ***
Below
See ***
Below
See ***
Below
See *** Below
$0
*VBA has a FY 2014/2015 contract that includes Public Service Announcement (PSA) development. Airing of radio and TV PSAs are
through donated air time.
**VHA does not centrally track costs associated with outreach events.
**The total VHA advertising dollars spent by program offices, VISNs, and VAMCs for FY 2015 is $27,647,865.
***All FY 2015 National Veterans Outreach Advertising and outreach activities were pre-paid with FY 2013 and FY 2014 dollars.
The National Veterans Outreach (NVO) office, in collaboration with respective VA

administration and OSVA special assistant staff outreach leads, comply with the
premise that outreach is undertaken by VA to increase awareness of VA benefits
and services and how to access them. The information provided in the preceding
outreach responses entail the major categories in which outreach is planned and executed: advertising, event participation and through on-line engagement. Where appropriate, funding for those outreach programs is reported. Increasingly, VA is expanding outreach to better engage through public private partnerships. VA is presently developing policy to help guide public private partnerships while VHA, in particular, is developing best practices and procedures as part of their community engagement mission. There is no funding line identified at this time for establishing
public private partnerships across VA. VA will report all outreach activities conducted in accordance with title 38U.S.C, Chapter 63, for the submission of the biennial report.
Question 86. Please provide a detailed budget for the National Veterans Outreach
Office (NVO), including the number of FTE, a leadership chart, requested appropriations and budget projections, and current outreach initiatives and projects underway.
Response. Number of FTE: 4
FY 2015 Budget Forecast

Object Class
24
25
26
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Amount
(Printing & Reproduction) ..................................................................

(Contracts: Advertising, Outreach) .....................................................
(Supplies & Materials) .......................................................................
$45,000
$4,080,000
$3,600
Total ...........................................................................................
$4,128,000
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Current Outreach Initiatives:

Contract management and execution of the media buy and Web development
contract for the VA Explore Web site.
Management and preparation of the Congressionally-mandated Biennial Outreach Report.
Planning, coordination, and execution of the National Veterans Day Observance
at Arlington National Cemetery.
Planning for an outreach training program as part of the 2014 OPIA National
Training Academy.
Quarterly updates with VSO/NGO communications leads on VA Outreach Initiatives and teaming opportunities.
Question 87. In response to questions about the fiscal year 2014 budget request
regarding what metrics NVO uses to determine whether a program is duplicative,
VA stated: NVO leadership and team members confer regularly with other VA Staff
Offices and with all three VA Administrations to review the status of current programs and review proposals for new projects. Through this detailed process, potential for duplicity is identified and plans developed to ensure programs that may be
duplicative in nature are not executed by NVO.
A. During fiscal year 2014, which outreach programs or projects were identified
as duplicative? Please list all programs and projects that were identified.
Response. VA purchased digital keyword advertising with Google and Bing for the
VA Explore outreach campaign. The Veterans Health Administration (VHA), at the
VISN level, submitted some of the same keywords for use in a local campaign. VA
and VHA compared the lists of search terms for the campaigns and the zip codes
of the areas targeted. The two groups negotiated which terms each campaign would
purchase and determined the best way to optimize both campaigns while avoiding
conflicts.
B. Which programs were not implemented because of this determination?
Response. No advertising campaign was terminated.
Office of Congressional and Legislative Affairs
Question 88. For fiscal year 2015, the Office of Congressional and Legislative Affairs requests $6 million and 45 employees. Please provide a list of the positions
that would be filled with that funding and the pay-grades for those positions.
Response. The 45 positions and their corresponding pay-grades are as follows:
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312Bur86c.eps
Assistant Secretary ......................................................................................................................

Director Congressional Affairs .....................................................................................................
Associate Deputy Assistant Secretary ..........................................................................................
Director of Operations ..................................................................................................................
Director, Benefits Legislative Service ..........................................................................................
Director, Health Legislative Service .............................................................................................
Director, Legislative Service .........................................................................................................
Director, Corporate Enterprise Legislative Service ......................................................................
101
Director, Congressional Reports and Correspondence .................................................................
2Special Assistants .................................................................................................................
2Administrative Officers ..........................................................................................................
Executive Correspondence Analyst ...............................................................................................
13Congressional Relations Officers ........................................................................................
Government Accountability Office (GAO) Liaison Officer .............................................................
6Program Analysts ...................................................................................................................
Assistant Director, Congressional Liaison Service ......................................................................
Senior Congressional Liaison Representative ..............................................................................
Congressional Liaison Officer ......................................................................................................
3Congressional Liaison Representatives .................................................................................
Staff Assistant .............................................................................................................................
3Congressional Liaison Assistant ...........................................................................................
Program Assistant ........................................................................................................................
GS-15
GS-15
GS-14
GS-14
GS-12/13/14
GS-14
GS-9/11
GS-14
GS-13
GS-13
GS-12
GS-11
GS-7/8/9
GS-8
Question 89. In response to questions regarding the fiscal year 2014 budget request, the Office of Congressional and Legislative Affairs indicated that, during fiscal year 2013, only 13 percent of questions for the record had been submitted on
time; 75 percent of testimony had been submitted on time; and only 24 percent of
reports had been submitted on time. By comparison, during fiscal year 2012, 75 percent of questions for the record had been submitted on time; 88 percent of testimony
had been submitted on time; and 68 percent of reports had been submitted on time.
Please explain the root causes for the increased delays during fiscal year 2013 in
providing this information to Congress and the deterioration in timeliness since
2012.
Response. During fiscal year (FY) 2013, the Office of Congressional and Legislative Affairs (OCLA) experienced a decrease in specific performance metrics while experiencing a dramatic increase in workload requirements. In FY 2013, the Department conducted 999 briefings, both as a result of Congressional requests and Departmental initiatives. This was a 45-percent increase over FY 2012. During
FY 2013, OCLA responded to 3,544 requests for information; a 29-percent increase
over the number responded to in FY 2012.
In 2013, OCLA developed a Workload Dashboard that identifies all of the congressional action items the office is currently working. As of March 20, 2014, the OCLA
Dashboard listed the following outstanding items:
8 Hearings
158 Congressional Requests for Information
101 Executive Congressional Correspondence items addressed to the Secretary
86 Questions for the Record
11 Hearing Deliverables
Additionally, OCLA is also working:
688 Congressional Constituent Casework Inquires
21 GAO actions
18 Requests for Technical Assistance on Legislation
52 Briefings within the next 30 days
The total volume of work constitutes over 1,000 concurrent action items. Given
this extensive volume of work, OCLA reviews and prioritizes its efforts to support
both the Department and Congress. Unfortunately, with such a large workload,
there will be items that will take longer to complete than we would like. In FY 2014
through the end of May 2014, the Department has responded to 94 percent of the
questions for the record on-time and has submitted 97 percent of its testimony ontime.
Question 90. In response to questions regarding the fiscal year 2014 budget request, the Office of Congressional and Legislative Affairs indicated that, during fiscal year 2014, its goal was to submit 90 percent of questions for the record on time;
to submit 90 percent of testimony on time; and to submit 85 percent of reports on
time.
A. To date, are those goals being met? If not, please identify the percent of questions for the record, testimony, and reports that have been submitted on time during
fiscal year 2014.
Response. In FY 2014 through May, 2014, OCLA had achieved the following
results:
Percent of Questions for the Record submitted on time: Goal 85 percent/Actual
94 percent
Percent of Testimony submitted on time: Goal 90 percent/Actual 97 percent
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Percent of Congressionally Mandated Reports submitted on time: Goal 85 percent/Actual 18 percent
B. Are there any personnel consequences for any VA employees (such as in performance reviews or receipt of bonuses) caused by failure to meet those goals? If so,
please specify which employees and the potential consequences.
Response. OCLA employee performance plans include provisions regarding meeting performance measures and metrics which directly affect the employees overall
performance rating. The overall performance rating determines whether an employee will be recommended for a potential performance award.
Question 91. For fiscal year 2015, please identify the goals set by the Office of
Congressional and Legislative Affairs for submitting questions for the record, testimony, and reports on time.
Response. For FY 2015, OCLAs target goals are as follows:
Percent of Questions for the Record submitted on time:
85 percent
Percent of Testimony submitted on time:
90 percent
Percent of Congressionally Mandated Reports submitted on time:
85 percent
Question 92. According to information in the fiscal year 2015 budget request, the
Office of Congressional and Legislative Affairs (OCLA) stated: In 2013, OCLA supported 62 hearings and conducted over 999 congressional briefings, including educational seminars. OCLA responded to 3,544 requests for information in addition to
477 questions for the record.
A. How many briefings, requests for information, and questions for the record submitted in 2013 were not answered or fulfilled by December 31, 2013?
Response. At the end of calendar year 2013, OCLA had the following workload:
Briefings: 41 (includes Congressionally requested and Departmental proposed
briefings within 30 days)
Requests for Information: 119
Questions for the Record: 625
B. How long, on average, did it take OCLA to respond to requests from the Hill?
Response. VA strives to provide Congress with accurate and quality information
in a timely manner. As indicated in FY 2013, OCLA facilitated over 999 congressional briefings (45-percent increase over FY 2012), including educational seminars,
responded to 3,544 requests for information (29-percent increase over FY 2012), and
provided responses to 477 questions for the record. OCLA also supported 311 requests for technical assistance on proposed legislation. OCLA facilitated 51 GAO
Entrance Conferences, 36 Exit Conferences, and responded to 31 Draft Reports and
35 Final Reports. Given the complexity, and competing priorities of many requests,
not every request for information receives a response within requested timeline.
OCLA is working to improve its communications with Congress regarding priorities
to ensure needed information is received on time. OCLA does not maintain an average time to completion statistic for responding to Congressional requests.
Office of Acquisition, Logistics, and Construction
Question 93. For fiscal year 2015, the Office of Acquisition, Logistics, and Construction requests $9.5 million for Other Services. Please provide a specific itemized
list of how these funds would be spent. To the extent any of these funds will be
spent on contracts, please explain the nature of the contract and the expected outcomes.
Response. The $9.5 million in the fiscal year (FY) 2015 Office of Acquisition, Logistics, and Construction (OALC) budget request includes the expenditure categories
shown in the chart below.
Obligation Type
Amount
Permanent Change of Station Obligations ...............................................

Repair of Furniture and Equipment, Equipment Rental ..........................
Department of Homeland Security Services .............................................
Recurring Maintenance and Repair ..........................................................
Training .....................................................................................................
Contracts ...................................................................................................
$700,000
57,000
463,000
50,000
362,000
7,832,000
Total .................................................................................................
$9,464,000
The $7.8 million for contracts includes the items shown in the chart below.
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FY 2015
Comments
$370,000
Financial Service Center Memorandum

of Understanding (MOU)
MOU between VA centralized accounting and finance center and

Construction and Facilities Management (CFM) for necessary
support.
$140,000
Interagency Agreement Historic American Buildings Survey (HABS)
Documentation of VAs most significant historic properties, National Historic Landmarks, in compliance with Section 110 of
the National Historic Preservation Act to document the official
Historic American Building and Landscape Surveys submitted
to the Library of Congress.
$500,000
Base Competency Scheduling
Contract to continue development of competencies which are

general to Construction Management and apply to all roles
and positions.
Federal Facilities Council (FFC)
National Academy of Sciences contract in support of FFC activities to identify advancing technologies, processes, and management practices to improve the planning, design, construction, management, operation and evaluation of Federal facilities.
$293,000
US Army Corps Engineers Interagency

Agreement
Engage the Army Corps of Engineers to review major construction projects.
$262,041
Miscellaneous
Multiple small contracts for less than $10,000 each.
$150,000
Human Capital Investment Plan Reimbursement
Reimbursement for Human Resources and Administration services to CFM for support of recruitment, hiring and employee
development training programs.
LYNX Photo Management
Secure construction photo management software support annual

renewal.
National Institute of Building

SciencesCII Benchmarking
The contract is for participation in a research project that will

establish industry benchmarks for medical facilities. The 2year study concludes with this second year of funding. VA
was a cosponsor of the research project to facilitate
benchmarking VA medical facility contribution to other medical facility construction projects. The outcome will allow VA
to evaluate projects and processes to define future improvements.
Defense Finance and Accounting Service (DFAS)
Interagency agreement to process VA and CFM payroll.
OALC Front Office
Mission support service contract(s).
$2,000,000
Plans and Programs Construction Review Council (CRC) and Program

Management (PM) Support contracts
This effort will provide support to CFM in the implementation

and reporting of the capital program improvement plan. The
contract will provide support documentation and tracking of
improvements in the construction process.
$1,000,000
Construction Project Management

TRIRIGA
This effort continues the sustainment of the TRIRIGA software for

construction management. The software will provide a collaborative construction management tool for VA. The utilization of this product will improve contract administration and
project oversight.
Corporate and Regional Matrixed Budget System (CRMBS) Post Production

Support contract
Provide post-production support on an existing Government-OffThe-Shelf product to include bug-fixes, security updates, routine maintenance and updates to ensure compliance with US
Congress Rehabilitation Act to make their electronic and information technology accessible to people with disabilities.
$30,000
$35,000
$170,000
$50,959
$200,000
$750,000
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FY 2015
Description
Comments
$1,691,000
VA Facilities Management School MOU
MOU with the Department of Veterans Affairs Acquisition Academy (VAAA), to develop multi-modal delivery of comprehensive
curricula of educational programs and courses relevant to
VAs infrastructure and the total healthcare environment.
Advisory Council Historic Preservation

Liaison
Renewal of Interagency Agreement to provide dedicated support

to VA on complex and controversial historic preservation
issues.
$190,000
$7,832,000
Total
Question 94. The fiscal year 2015 budget request for Construction, Major Projects,
includes a request of $75.5 million for the Advanced Planning Fund. This appropriated fund is comprised of no year money and is used to develop the early stages
of construction projects for VHA, the National Cemetery Administration, the Veterans Benefits Administration, and VA central office staff offices.
A. To date, what is the unobligated balance of the Advanced Planning Fund?
Response. As of March 31, 2014, the unobligated balance is $180 million.
B. For fiscal year 2015, please provide a detailed description and amount for each
project expected to be funded through the Advanced Planning Fund.
Response. VA plans to obligate $107.8 million for the remainder of FY 2014. The
table below reflects the anticipated use of the Advanced Planning Fund in FY 2015:
Planned
Obligations
2015
Project
Bronx, New YorkSpinal Cord Injury (SCI) ...........................................................................................................

Perry Point, MarylandReplace Community Living Center (CLC) ........................................................................
Livermore, CaliforniaRealignment and Closure Palo Alto (Design) ..................................................................
Long Beach, CaliforniaSeismic Correction Building 7 and 126; Demolition Building 7 ..................................
Long Beach, CaliforniaMental Health and CLC ................................................................................................
Palo Alto, CaliforniaAmbulatory Care/Polytrauma Rehab ..................................................................................
Portland, OregonRetrofit and Renovation ..........................................................................................................
San Francisco, CaliforniaSeismic Retrofit B 1,6 and 8/Replace B12 ..............................................................
American Lake, WashingtonBuilding 81 Seismic Replacement ........................................................................
West Los AngelesNew Tower and Building 500 Seismic Correction .................................................................
West Los Angeles12 Buildings Seismic Upgrade ..............................................................................................
National Cemetery Administration Projects ...........................................................................................................
Staff Offices ...........................................................................................................................................................
Veterans Benefits Administration Projects ............................................................................................................
Historic Preservation, Environmental, and Cost Estimating Services ...................................................................
Facilities Standards and Criteria ...........................................................................................................................
Integrated Strategic Master Plans .........................................................................................................................
$2,000,000
$300,000
$2,000,000
$200,000
$300,000
$3,000,000
$17,000,000
$200,000
$7,000,000
$25,000,000
$3,200,000
$11,000,000
$4,000,000
$1,000,000
$7,400,000
$20,000,000
$30,000,000
$133,600,000
C. Please describe in detail the metrics used to determine the size of the budget
request for the Advanced Planning Fund?
Response. VAs request for this line item is based on the estimated need to support project and other requirements funded through this fund. VAs Advanced Planning Fund line item provides funding for schematic design, design development, and
construction document phases up to 100 percent of design for Major Construction
projects. This will allow VA to complete at least 35 percent of total design prior to
requesting construction funds. It can be used to prepare facility master plans, historic preservation plans, conduct environmental assessments and impact studies, energy studies or audits, and design and construction-related research studies including post-occupancy evaluations. The funds are also utilized to maintain construction
standards, such as: design guides, design standards, specifications, and space criteria.
Question 95. VA has a large inventory of buildings across the Nation to carry out
its mission. According to a response to questions about the fiscal year 2014 budget
request, VA expected to have approximately 941 unused or underutilized buildings.
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A. In fiscal year 2013, how much, if any, cost avoidance or savings did VA realize
by selling vacant or underutilized buildings and how many vacant or underutilized
buildings did VA have at the end of fiscal year 2013?
Response. At the end of FY 2013, VA had approximately 922 vacant or underutilized buildings, of which 427 (46 percent) were historic buildings. Of the 922, 242
were vacant and 680 were underutilized.
The 922 buildings account for approximately 9.9 million square feet (SF) of space
in vacant or underutilized buildings. Of that total, 4.2 million SF is located in vacant buildings and 5.6 million SF is located in underutilized buildings.
VA does not track actual costs at the building level; however, the Department
does use a proration methodology to report building level costs to the Federal Real
Property Profile annually. For FY 2013, VA estimates it spent approximately $20.2
million on the 922 vacant and underutilized assets in its portfolio. A further breakdown of those costs is an estimated $4.6 million on the 242 vacant buildings and
$15.6 million on the 680 underutilized assets.
Compared to FY 2012, when the estimated cost to operate vacant and underutilized buildings was $23.4 million annually, the FY 2013 estimated cost ($20.2 million) represents a cost avoidance of approximately $3.2 million. The reduction in operating costs for these buildings is the result of reuse and disposal of vacant and
underutilized buildings; it is not the result of revenue gained from selling any properties. VA did not sell any vacant or underutilized properties in FY 2013.
B. In fiscal year 2014, how much, if any, cost avoidance or savings does VA expect
to realize by selling vacant or underutilized buildings and how many vacant or underutilized buildings does VA expect have at the end of fiscal year 2014?
Response. VA projects it will dispose or reuse 5060 vacant or underutilized buildings in FY 2014, resulting in an estimated 867 vacant or underutilized buildings at
the end of FY 2014. Of that 867, approximately 197 are projected to be vacant and
670 underutilized.
Based on the planned disposal or reuse of 5060 buildings, the overall cost to operate vacant and underutilized buildings is projected to drop to $19.7 million annually in FY 2014, a reduction of approximately $0.5 million from the FY 2013 amount
($20.2 million). The projected reduction in operating costs for these buildings is the
result of reuse and disposal of vacant and underutilized buildings; it is not the result of revenue gained from selling any properties.
VA continues to pursue disposing or reusing un-needed assets; however, there are
challenges in further reducing VA inventory in this area. Of the projected 867 vacant or underutilized assets, 391 (45 percent) are considered historic buildings, limiting VAs ability to dispose or reuse these assets in many cases.
Competing stakeholder interests in some of these vacant or underutilized assets
also has hampered disposal or reuse efforts. VA is looking at further opportunities
to reduce our vacant and underutilized footprint, as mentioned earlier. Having tools
in place, such as the expansion of VAs Enhanced-Use Lease (EUL) authority, currently in proposed legislation under consideration by Congress, would help overcome
some of these challenges and allow VA to more effectively reduce its inventory of
vacant and underutilized assets.
Question 96. The Office of Small and Disadvantaged Business Utilization
(OSDBU) is an office within the Office of the Secretary, although the budget for the
office is paid for by the Office of Acquisition and Logistics Supply Fund.
A. Please provide a detailed budget for OSDBU, including FTE and requested
budget for fiscal year 2015.
Response. Because the Office of Small and Disadvantaged Business Utilization
(OSDBU) is funded by the Supply Fund, the OSDBU budgeting cycle is not the
same as the Presidential budget request. The OSDBU 2015 budget request is due
to the Supply Fund Board in August 2014 and is currently under development. The
following budget history is provided:
OSDBU Total Budget

($ in thousands)
2012 Actual
VA Veteran-Owned Small Business Verification ..............

Strategic Outreach ...........................................................
Acquisition Support ..........................................................
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2013 Actual
2014 Estimate
Budget
FTE
Budget
FTE
Budget
FTE
$11,892
$7,050
$761
19
8
6
$16,818
$1,645
$1,087
19
7
7
$18,545
$4,814
$1,892
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OSDBU Total BudgetContinued
($ in thousands)
2012 Actual
Budget
2013 Actual
2014 Estimate
FTE
Budget
FTE
Budget
FTE
Operations ........................................................................
$878
$10,866
$5,112
10
Total Expenditures ...................................................
$20,581
42
$30,416
42
$30,363
41
B. Please provide a detailed budget for the Center for Verification and Evaluation
(CVE) within OSDBU, including FTE, requested budget for fiscal year 2015, and
metrics used by CVE to measure effectiveness.
Response. Because the Center for Verification and Evaluation (CVE) is within the
Office of Small and Disadvantaged Business Utilization (OSDBU), which is funded
by the Supply Fund, the CVE budgeting cycle is not the same as the Presidential
budget request. The OSDBU 2015 budget request is due to the Supply Fund Board
in August 2014 and is currently under development. The following budget history
is provided:
CVE Budget
($ in thousands)
2012
Actual
2013
Actual
2014
Estimate
FTE ....................................................................................................................................
Obligations:
FTE ................................................................................................................................
Professional Services ....................................................................................................
Travel ............................................................................................................................
Training ........................................................................................................................
Printing and reproduction ............................................................................................
Contract Support ..........................................................................................................
Supplies and materials ................................................................................................
Equipment ....................................................................................................................
Rents ............................................................................................................................
Security .........................................................................................................................
19
19
16
$ 1,874
$0
$7
$0
$0
$9,912
$97
$2
$0
$0
$2,166
$6,630
$37
$669
$0
$7,246
$29
$41
$0
$0
$1,778
$7,537
$30
$8
$0
$8,912
$13
$7
$240
$20
Total obligations ......................................................................................................
$11,892
$16,818
$18,545
Department of Veterans Affairs (VA) has invested heavily in building a robust

and effective system for verifying Veteran-Owned Small Business eligibility for the
VA Veterans First Program. In fiscal year (FY) 2013 we spent $6.9 million to build
verification capacity and in FY 2014 we are spending $12.3 million in non-recurring
investments to ensure that the system is efficient and cost-effective. As a result we
expect the verification program costs to be approximately $14.7 million in FY 2015
to handle 6,000 applications.
Metrics used by CVE to determine effectiveness:
Total applications processed
Number of initial applications processed
Number of requests for reconsideration processed
OFFICE OF INSPECTOR GENERAL
Question 97. For fiscal year 2015, the Office of Inspector General requests $11.8
million for Other Services. Please provide an itemized list of how those funds would
be utilized.
VA OIG Response: The fiscal year (FY) 2015 request for Other Services includes
the following contractual services, interagency agreements, employee training, VA
cross-cutting services, and other procured services:
Consolidated Financial Statement Audit contract for FY 2015
Human Resources/Payroll Processing ServicesDepartments of Treasury and
Agriculture
Federal Information Security Management Act Review contract
Employee Training
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VA Franchise Fund ServicesInformation Technology processing, financial
services, employee relocation services, background investigations, and records
storage
Council of the Inspectors General for Integrity and Efficiency
Building security servicesDepartment of Homeland Security and VA
Investigative Servicescredit/database access, forensic examinations, transcription services, fingerprinting, communications agreements
Other miscellaneous administrative/support services provided by VA and other
sources.
Question 98. With the requested level of resources for fiscal year 2015, how many
benefits inspections would the Office of Inspector General plan to conduct?
VA OIG Response: The Office of Inspector General plans to conduct 20 inspections
of VA Regional Office operations in FY 2015. Our independent inspections provide
recurring oversight focused on disability compensation claims processing and the
performance of Veterans Service Center operations.
VETERANS HEALTH ADMINISTRATION
Question 99. According to the budget request, VA will spend $534 million to activate medical facilities in fiscal year 2015. And, the estimate for activations for fiscal
year 2015 increased $404 million over the amount included in advanced appropriations.
A. Please break out the $534 million by appropriations account.
Response. Please refer to the table below:
Medical Services .........................................................................
Medical Support & Compliance .................................................
Medical Facilities .......................................................................
$395,416
$42,800
$96,200
Activations, 2015 Estimate ...............................................
$534,416
B. How much, in total, does VA intend to spend in fiscal year 2016 for medical
facility activations? Please break this figure out by appropriations account.
Response. Please refer to the table below:
Medical Services .........................................................................
Medical Support & Compliance .................................................
Medical Facilities .......................................................................
$96,200
$10,400
$23,400
Activations, 2016 Estimate ...............................................
$130,000
C. Please provide a full list of the facilities that will be activated with these funds,
with the amount of funding estimated for each facility broken down into non-recurring and recurring costs.
Response. Please see attached.
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D. Please provide a detailed explanation for the $404 million increase above the
advanced appropriations amount for medical facility activations for fiscal year 2015.
Response. Please refer to above attachment.
110
Question 100. In an effort to ensure veterans are getting the mental health care
they need, VA recently ended an initiative to hire 1,600 new mental health providers and more than 900 Peer Specialists. This effort also included filling the open
positions that already existed within the mental health program.
A. To date, what is the number of mental health positions currently unfilled?
Response. As of June 2014, the current number of unfilled positions for mental
health is 2,762.83, which is a vacancy rate of 10.15 percent. For peer specialists the
vacancy rate is 7.7 percent.
B. Have all mental health providers hired under this initiative been trained in
evidence-based therapies? If not, when will the providers be trained?
Response. No. All mental health providers hired have not been trained in evidence-based psychotherapies. Determination of the need for training in evidencebased psychotherapies is based on clinical role, provider credentials, and program
assigned. For example, while some of the staff hired included registered nurses,
their role is to provide case management services and not evidenced-based psychotherapy. Since May 2012, VA has trained 3,446 unique VHA staff and trainees (not
including Vet Center) in one or more of the 15 evidence-based psychotherapies that
have centralized training. The tracking database cannot distinguish between staff
hired as a result of the initiative and those hired before the initiative. Training in
evidenced-based therapies is an ongoing process based on expansion of these therapies as well as staff turnover.
C. Have all the Peer Specialists been trained and are they currently providing
care to veterans? If not, when will they be trained? Please provide the Committee
with a list of facilities that received Peer Specialists positions and the number of
Peer Specialists at each facility.
Response. VHA currently has 952 peer support staff hired or converted to support
the hiring initiative, delivering services to Veterans at every medical center and at
every very large CBOC. (Please note, as of April 2014, very large is defined as a
CBOC that has more than 10,000 Veterans enrolled.) VHA hired 420 Peer Specialists who were already trained and certified and have been providing counselor services upon being hired. VHA has trained and certified 564 Peer Support Apprentices;
202 Peer Support Apprentices have since been promoted to Peer Specialists and the
remaining 362 Peer Support Apprentices are waiting their 12-month time limited
appointment requirement before eligibility for promotion to Peer Specialist. VHA
has 22 Peer Support Apprentices scheduled for training and an additional 24 Peer
Support Apprentices awaiting confirmation on scheduled training. Attached below
is a complete facility listing and the number of peer-to-peer counselors per facility.
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Question 101. According to the budget request, VA estimates a net increase in

enrollment will be 56,000 in 2014 and 63,000 in 2015 due to the mandate that all
Americans have health care under the Affordable Care Act. How many veterans
does VA estimate would leave the system for other health care in 2014 and 2015?
Response. VA has been closely monitoring Veteran enrollment in response to
ACA, but it is likely still too early to assess changes in enrollment and to attribute
them directly to the ACA. VA can report that of the Veterans to whom VA sent ACA
outreach letters, almost 7,150 enrolled in VA health care after receiving such a letter (through February 2014). From July 2013 through January 2014, VA also received 252 requests from Veterans to disenroll from VA health care. Although Veterans are not required to provide a reason for enrolling or disenrolling, and other
factors may also influence Veterans decisions to enroll in or disenroll from VA
health care, only 49 Veterans requested to disenroll during the same 6-month timeframe in the previous year (July 2012 through January 2013). The experience to
date in 2014, based on this data, for both enrollment and disenrollment, is lower
than originally projected in the budget request. VA will continue to monitor the im-
117
pact of ACA on the VA health care system and make necessary changes to future
budget estimates.
As background, the analysis to estimate the impact of ACA on VA health care was
based on data from three sourcesthe 2010 Public Use Microdata Sample files from
the American Community Survey (ACS), The Lewin Groups Health Benefit Simulation Model (HBSM), and VAs EHCPM. The HBSM predicts how Veterans health
care choices might change as a result of ACA. This model was used to estimate the
change in VA enrollment (both those enrolling and those leaving VA for other coverage) in response to the ACA. For an individual with a given primary health coverage status before ACA, the HBSM predicts the individuals likelihood of remaining
in the same primary coverage status or transitioning to another status after implementation of ACA. These likelihoods are based on individual-level factors that are
also modeled, such as the individuals Federal poverty level, whether the individual
is employed, employer type, and employer size. The results of the analysis suggested
that most Veterans who have employer-provided insurance as their primary insurance will not have a change of status as a result of ACA, nor will Veterans who
have coverage provided by Medicaid, Medicare, TRICARE, or the Indian Health
Service. According to The Lewin Groups initial assessment, the vast majority of
Veterans will not choose to change their source of health care coverage as a result
of the ACA.
Veterans who are most likely to newly enroll in VA health care to obtain minimum essential coverage are Veterans who currently have no health coverage. The
2010 ACS data indicate that about 1.4 million Veterans have no form of health coverage. About 1 million of these Veterans may be eligible to enroll in VA by meeting
VAs income-eligibility requirements. However, because many of these Veterans may
also be eligible for Medicaid or for tax credits if they buy insurance in the health
insurance marketplaces, not all of them are likely to enroll in VA health care.
Veterans who are likely to obtain non-VA coverage in response to the ACA are
those who rely very little on VA for their health care. There are about 924,000 Veterans in this category. Some of them are expected to disenroll from VA in order to
avail themselves of premium tax credits (if otherwise eligible) to purchase qualifying
coverage in the health insurance marketplace. Another portion of this group would
enroll in Medicaid if their state expands Medicaid coverage and some would take
up employer-provided insurance in response to the ACA. Veterans who obtain coverage through Medicaid or employer-provided insurance are not expected to
disenroll from VA (and instead maintain dual enrollment), but their reliance on VA
is likely to decline.
Question 102. VA provides dental care to veterans who are 100 percent serviceconnected disabled, for dental conditions that are service-connected, or care that is
medically necessary. In addition, VA provides access for veterans to dental insurance through the VA Dental Insurance Program.
A. Please describe in detail the metrics VA uses to measure access to VAs dental
clinics.
Response. VA uses access measures to quantify how many patients waited and
how many are currently waiting for care. Dental clinics use the same access metrics
that are used for all VA medical appointments. The VHA Support Service Center
Wait Time Pending report was designed to help reduce the number of future appointments with long waits. The report shows the number of patients and appointments in the queue but gives greater detail for those patients who have already
waited more than 14 days from the recorded create date for an upcoming visit.
B. What is the current wait time for an appointment in a VA dental clinic? Please
break this information out by facility.
Response. As of June 30, 2014, 5.50 percent of all pending dental appointments
for new patients were greater than 14 days of the create date. The facility specific
access list report is attached.
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Embedded in the above spreadsheet, five pages:
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C. How many open positions does VA currently have for dental providers and on
average how long does it take to hire a dental clinician?
Response. As of July 15, 2014, there are 20 dentist vacancies and 2 dental hygienist vacancies listed on the USAJobs Web site. As of April 2014, the average SOH
timeframe to hire dental clinicians is 41.99 days, which exceeds the VA SOH goal
of 60 days. The SOH metric begins with the date request received through the date
of tentative offer.
D. Please submit to the Committee the Dental Patient Satisfaction Survey.
Response. Please see attached eight pages.
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Question 103. In a response to a question about the fiscal year 2014 budget request on consolidating VHA Fee Programs processing system, VHA indicated they
had not consolidated in the same manner as the Consolidated Patient Account Centers (CPAC) but had begun work on a centralized claims processing system, known
as * * * Health Claims Processing (HCP). Please provide the Committee a detailed update on the implementation of HCP.
Response. HCP was chartered by VA to demonstrate the use of VAs Financial
Service Center (FSC) to process health care claims for Non-VA Medical Care (previously known as FEE). The project is managed by the VHA Chief Business Office
(CBO) in a partnership with the FSC. The FSC supports CBO with claims processing support for several VISNs experiencing high claim volume/ backlogs. For
claims processed by FSC, VAMCs continue to be responsible for the Non-VA Care
Coordination component, which includes eligibility determination and authorization
for Purchased Care.
In addition, FSC has supported CBO in developing two HCP modules which support and introduce improvements to the upfront processes of Non VA Care including
eligibility determinations as well as the authorization of inpatient care in the com-
135
munity (known as Hospital Notification). The Eligibility module is in production use
at 3 VAMCs and is in the process of being integrated with the existing Fee Basis
Claims System (FBCS). The national release of this functionality is currently scheduled to begin in March 2015. The module for Hospital Notification is scheduled for
a January 2015 deployment to a second VAMC for testing and will be integrated
with FBCS in the second half of 2015.
Question 104. Because information on VISN headquarters funding was left out of
last years request, Ranking Member Burr submitted a question for the record asking [h]ow much does VA expect to spend in fiscal years 2014 and 2015 for VISN
headquarters functions? While VA never answered the question, this years budget
request provided the answer.
A. What accounts for the $115 million increase between fiscal year 2013 and 2014
at a time when VA was reducing the size the VISN staff?
Response. There was a $105 million increase in obligations from 2013 actuals to
2014 estimate. The 2013 actual of $186.8 million reflects actual obligations at the
end of the fiscal year for the VISN headquarters only. The 2014 estimate of $291.6
million reflects projections for VISN headquarters and includes consolidated VISN
functions, such as laundry, laboratory, and human resources. In 2013, these funds
were initially sent to the VISN headquarters and then disseminated to the VAMCs.
FY 2014 reflects a transition year for how these funds are initially disseminated to
the field.
B. VISN Directors were given a deadline of December 31, 2013, to reduce their
staff to no more than 65 FTEs; why did VISN 23 miss this target date? Please describe what remedies are being put in place to help VISN 23 reach the target.
Response. VISN 23 was compliant with the required staffing levels, with the exception of Bio-Medical Engineering and Health Care Technology which they requested to function as a consolidated service. The VISN Staffing Workgroup is conducting a review of all requests for consolidated service to validate those occupational functions which are best suited for consolidation.
If VISN 23s Bio-Medical Engineering/Health Care Technology proposal is approved, the staff are either moved to a consolidated service account or dispersed
back to the local medical facilities. The VISN would then be 8 full-time equivalent
employees (FTEE) under their currently approved ceiling of 59 FTEE.
C. In a meeting with Ranking Member Burr in 2012, senior VHA officials indicated they planned to reduce the number of VISN staff first, and then explore the
overall number of VISNs needed. Has the second phase started? If not, when does
VA expect to begin this phase of the VISN reorganization?
Response. The former Under Secretary for Health convened a workgroup in 2013
to review the composition of VISNs relative to Veteran population, health care service complexity levels, geography, budget, and other factors that are unique to each
VISN. The workgroup developed the criteria and methodology that would be used
to review the size and composition of the VISNs. The workgroup presented its findings and recommendations to VHA leadership in late 2013. VHA leadership instructed the review team to reevaluate certain criteria and revise recommendations
for consideration. These recommendations were to provide for a tiered or staggered
approach to any reorganization effort that would allow for a phased implementation
of any changes.
Question 105. The Honoring Americas Veterans and Caring for Camp Lejeune
Families Act was signed into law 18 months ago. VA started treating Camp Lejeune
Veterans in August 2012 when the President signed the law; however, family members are still waiting. When will VA start processing claims for Camp Lejeune
families?
Response. VA can begin reimbursing eligible Camp Lejeune family members now
that the interim final rule has been published and is effective. The interim final rule
was published in the Federal Register on September 24, 2014 and became effective
on October 24, 2014. Now that the Camp Lejeune family member rule is effective,
VA will reimburse family members, as the last payer, for health care costs that are
related to the 15 conditions in the law and were incurred from March 26, 2013, the
day the Congressional appropriations were made, onward.
Question 106. In response to a question by Chairman Sanders in the Committee
hearing on the budget about what debt forgiveness programs are available to attract
primary care physicians to work for VA, Dr. Petzel stated the $60,000 cap of the
Education Debt Reduction Program (EDRP) could be higher. In fact, the Caregivers and Veterans Omnibus Health Services Act authorizes the Secretary to waive
the $60,000 cap. In addition, the budget request states EDRP was not utilized to
the extent expected for the Mental Health Hiring Initiative (MHHI).
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A. How many times has the Secretary waived the $60,000 cap? Please provide a
list by provider type and the amount of debt eventually paid.
Response. No Education Debt Reduction Program (EDRP) applicants have requested a waiver above the $60,000 cap; therefore, no waiver requests have required
Secretary action/approval.
B. How did VA expect to utilize EDRP for MHHI? Please provide a detailed explanation of why it was not utilized as envisioned.
Response. In May 2012, VHA dedicated funding for 1,000 EDRP awards specifically for title 38 and hybrid title 38 permanent hires for the Mental Health Hiring
Initiative (MHHI). All VISNs and facilities were notified of the availability of these
funds to enhance their recruitment and retention efforts. Each facility is responsible
for determining which positions are hard to recruit and include the EDRP incentive
in the vacancy announcement accordingly. Over 4,000 clinical mental health professionals have been hired as part of the MHHI; 634 vacancy announcements for
MHHI positions included the offer of the EDRP incentive. Of the employees hired
from those vacancy announcements, 109 new employees have applied and been approved for EDRP in the amount of $5,243,001. As of April 1, 2014, there are 27
MHHI Psychology hires that have been offered EDRP but cannot apply until they
have been licensed and converted to an excepted appointment. While VHA anticipated more EDRP usage for this important hiring initiative, there are a number of
reasons it may not have been used to the extent expected. In particular, not all
newly hired mental health professionals have qualifying education loan debt, and
facilities may have determined that many of the positions hired were not hard to
recruit. For example, pay for social workers in VHA is considered quite competitive
with private sector, and nearly one-fourth of the clinical professionals hired as part
of the MHHI were social workers. A survey of EDRP Coordinators is being conducted to identify barriers to using the program; that may prove beneficial to understanding the programs usage.
Homelessness
Question 107. Since the beginning of the Administrations initiative to eliminate
veterans homelessness by 2015, VAs programs to assist homeless veterans have received a 67 percent increase in funding since fiscal year 2010. In 2013, there were
57,849 homeless veterans on any given night in January; however, this only represents a 24 percent decrease in the number of homeless veterans since 2010.
A. As we move into the end of rescue phase, how will the Administration define
success?
Response. VAs goal is a systematic end to Veteran homelessness, which means
there are no Veterans sleeping on our streets. Should Veterans become homeless,
or be at-risk of becoming homeless, VA will have the capacity to quickly connect
them to the help they need to achieve housing stability. The ultimate goal is that
all Veterans have permanent, sustainable housing with access to high-quality health
care and other supportive services that improve their quality of life.
B. What process will VA use to determine whether the rescue phase will need to
be extended beyond 2015?
Response. VA recognizes there will always be a rescue component to homelessness. An end to homelessness among Veterans does not mean that a Veteran will
never experience a housing crisis again. Changing economic realities and the unpredictability of life may create situations where a Veteran could experience or fall
back into homelessness, or be at-risk of homelessness. We can prevent the number
of homeless Veterans by identifying those who are most at-risk and quickly connecting them to programs that provide temporary financial assistance and access to
housing, health care, employment assistance and other supportive services that help
them obtain and sustain housing. Through coordination with other Federal and local
partners, each community will have coordinated entry systems that can rapidly connect the Veteran to housing, health care and other supportive services that not only
ends the episode of homelessness but promotes full reintegration back into the community. VA must also continue to utilize identified data to monitor its progress in
ending homelessness and, when necessary, make local adjustments based on need.
C. What steps has the Administration taken to ensure that, as the troop
drawdowns begin and continue over the next couple of years, these newly separated
servicemembers do not fall into homelessness?
Response. VA has put into place a robust integrated system of care that focuses
on both homeless prevention and rapid re-housing. Through its partnerships at the
Federal and local levels, VA is using data-driven solutions that are evidenced-based
and research-informed to quickly connect homeless Veterans to services and to prevent those at highest risk for becoming homeless to maintain housing. VA has coordinated with DOD to retool the Transition Assistance Program, which asks ques-
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tions related to housing and vocational instability. This partnership promotes VAs
capacity to more rapidly identify those most at risk for housing instability and connect them to preventative services, like the GI Bill, SSVF, benefits and other health
care supports to mitigate risk and promote greater community readjustment and
improved quality of life.
Question 108. The fiscal year 2016 advanced appropriation request currently has
a significant decrease in funding for current homeless programs. If VA does not
meet its goal for fiscal year 2015, will there be an increase in funding for homeless
programs for fiscal year 2016 and will this be an increase above fiscal year 2015
funding?
Response. VA must sustain the progress that has been made thus far by maintaining the level of resources that have been allocated to date. VAs FY 2015 budget
request calls for critical investments toward ending homelessness among Veterans
while strengthening our systems of care for all individuals and families who experience homelessness. Although the Point-in-Time (PIT) estimate is an important data
point for measuring progress, it is not the sole or primary data source VA uses to
draft its budget. In preparation for the FY 2015 Budget Submission, VA used its
own program evaluation data, poverty data, census data, and other health care data
sources. VA will use all of these data sources to evaluate the effectiveness of VAs
homeless programs and the PIT data to help adjust investments to priority communities where progress needs to accelerate to achieve the goal of ending Veteran
homelessness.
Progress to date demonstrates that when new resources are invested in proven
solutions and existing programs adopt best practices, it will be possible to end Veteran homelessness. To achieve the promise of ending Veteran homelessness, VA
needs both investments in known, effective programs and a continued transformation of our existing systems to help Veterans swiftly achieve and maintain permanent housing. VA will need continued support from Congress for targeted programs like HUD-VASH, SSVF, Continuums of Care-funded Permanent Supportive
Housing, Emergency Solutions Grants for Rapid Re-Housing and other programs
that increase access to safe, affordable, permanent housing.
Question 109. The fiscal year 2015 budget request includes an additional 10,000
Housing and Urban Development Veterans Affairs Supportive Housing (HUDVASH) vouchers, which would bring the total number of vouchers to roughly 68,155.
A. The fiscal year 2015 advance appropriation request submitted with the fiscal
year 2014 budget request did not include an additional 10,000 vouchers for fiscal
year 2015. What metrics were used to determine the need for additional vouchers
for fiscal year 2015?
Response. The most recent data available from the 2013 PIT Count, suggests that
there are still over 58,000 homeless Veterans on any given night. HUD-VASH
vouchers are a critical component of our system and its ability to house these Veterans. With so many Veterans still homeless, it is clear that additional vouchers
would be needed to end Veteran homelessness.
B. What is the total number of vouchers needed to meet the Administrations goal
of ending veterans homelessness by 2015?
Response. At this point in time, it is not possible to definitively state the total
number of vouchers needed to end Veteran homelessness. The total number of
vouchers needed is dependent upon future data points, which HUD and VA can only
estimate. The future data points include the future inflow of Veterans into homelessness, future placement rates accomplished with existing resources, and future
placements rates accomplished with any new resources.
Question 110. The fiscal year 2015 budget request includes a $200 million increase for the Supportive Services for Veteran Families (SSVF) program. Since the
beginning of SSVF, this program has seen a significant increase in funding each fiscal year. What type of analysis was conducted to determine the need for an additional $200 million in funding for fiscal year 2015?
Response. In determining the need for additional funding for the SSVF Program,
VA used a stock and flow analytic tool that included data from the national PIT
Count of homeless persons, VAs program utilization data, and national poverty data
to model future homelessness trends. Based on these results, VA was able to project
the number of homeless and at-risk Veteran families that would need access to
SSVF rapid re-housing and prevention services. This model showed a gap in services
that could impact VAs ability to end Veteran homelessness by the end of 2015. As
a result, VA requested an additional $200 million for SSVF. It is important to note
that SSVF emphasizes short-term crisis interventions that focus on the Veterans
needing time-limited support to help them stabilize in permanent housing. Once VA
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meets its goal of ending Veteran homelessness, SSVF will be able to shift resources
in order to prevent episodes of Veteran homelessness.
Question 111. Recently, VA changed the eligibility requirements for several programs, which has caused concern among the provider community.
A. How will the changes in eligibility requirements impact veterans seeking services through VAs homeless programs?
Response. No changes to VA homeless program eligibility requirements are in effect at this time. VA is currently reviewing the implications that changes in eligibility would have on Veterans and the homeless program provider community.
B. How many veterans currently seeking services will no longer be eligible for
services through VAs homeless programs?
C. What steps is VA taking to ensure that veterans who are currently receiving
services but will no longer be eligible for these programs are transitioned to other
community resources?
Question 112. In December 2011, VA signed 38 leases creating a public-private
partnership to develop housing units for homeless veterans. Through the Building
Utilization Review and Repurposing initiative, VA identified unused or underutilized property, which would create an additional 4,100 housing units. How many additional units of housing were available through this program in fiscal year 2013
and how many will be available by the end of fiscal year 2014?
Response. VA currently has approximately 1,674 units of housing available
through its EUL program. Of that number, 222 units are the direct result of EUL
leases that are part of the Building Utilization Review and Repurposing (BURR) initiative. In FY 2013, 74 units were made available, and in FY 2014, an additional
148 units will be brought online, totaling 222 units directly related to BURR.
Rural Health
Question 113. Project ARCH was established through Public Law 110387 to provide non-VA care to eligible highly rural enrolled veterans in five VISNs. This pilot
program is set to expire at the end of 2014.
A. Please provide the Committee with the total number of veterans who participated in this pilot and the total costs at each pilot site.
Response.
Unique
Veterans
Cost (Invoiced as
of February 2014)
1 ............................................................
6 ............................................................
15 ..........................................................
18 ..........................................................
19 ..........................................................
1,051
336
400
1,745
1,690
$3,914,105
$386,607
$345,233
$12,261,291
$19,544,700
Total ..............................................
5,222
$36,451,936
VISN
B. When does the Department plan to determine whether to extend and/or expand
this program?
Response. Section 104 of Public Law 113146, the Veterans Access, Choice, and
Accountability Act of 2014, extended Project ARCH for an additional two years, specifically until August 7, 2016. Section 104 specifies that the pilot program be carried
out in Veterans Integrated Service Networks (VISNs) 1, 6, 15, 18, and 19 (and such
other locations as the Secretary considers appropriate), and amends the eligibility
criteria under the pilot to include Veterans enrolled in VAs system of patient enrollment as of August 1, 2014. The legislation sets standards for timely scheduling and
occurrence of medical appointments under the pilot, requires outreach about the
pilot program, and requires VA to make use of existing contracts or, in lieu of extending current contracts, enter into new contracts to carry out the pilot program.
In carrying out Project ARCH, VA conducted competitive acquisitions and awarded contracts with performance periods established commensurate with the law. All
current contracts for Project ARCH were set to expire on September 30, 2014, but
a six month extension to those contracts was executed. On September 26, 2014 the
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President signed H.R. 5404 The Department of Veterans Affairs Expiring Authorities Act of 2014. Section 409 provides contracting requirement relief, permitting
sustainment of the existing contractors under Project ARCH. VA appreciates
Congresss support of Project ARCH, and is actively working contracting activities
to continue the pilot as required by Section 104.
Additionally, VA is working diligently to ensure Veteran access to care is not interrupted when Project ARCH concludes. VHAs Patient-Centered Community Care
(PC3) program will be available to rural Veterans to help bridge this gap.
Under PC3, VHA has contracted with Health Net Federal Services and TriWest
Healthcare Alliance to develop a network of providers to deliver covered care. This
will provide eligible Veterans coordinated, timely access to specialty care through
a comprehensive network of non-VA providers who meet VA quality standards when
VA cannot readily provide the specialty care in-house due to geographic inaccessibility, lack of available specialists, and other factors. PC3 contracts have been
awarded in six regions.
VA envisions the integration of PC3 will perpetuate increased access for Veterans
in distance-challenged areas, provide quality health specialty care within all applicable VISN locations, and systematically reduce cost over time to ensure Veterans
have accessible health care closer to their homes.
Question 114. In fiscal year 2014, the Office of Rural Health funded approximately
114 Rural Veteran Transportation Programs. Please provide the Committee with a
list of where these projects are currently located, how many veterans are participating, and what metrics are used to determine the success of these projects.
Response. The 14 Rural Veteran Transportation Programs are being used in the
following locations: Wilmington, Delaware; Beckley, West Virginia; Dayton, Ohio;
Danville, Illinois (two projects); Battle Creek, Michigan; Indianapolis, Indiana (two
projects); Iron Mountain, Michigan; Muskogee, Oklahoma; Harlingen, Texas; Spokane, Washington; Yuba City, California; Saginaw, Michigan.
In fiscal year 2014, VHA data indicates that these transportation programs served
14,494 rural Veterans and saved those Veterans over 379,000 travel miles. In addition, these projects have traveled 986,000 miles transporting rural Veterans in nearly 34,500 separate trips and an overall Veteran satisfaction rating 4.8 (5.0 scale,
with 5 indicating completely satisfied).
Long-term Care
Question 115. More than half of the veterans seeking healthcare through VA are
over the age of 65. As the veterans population continues to age, the Department will
be faced with challenges of chronic health conditions as well as increasing demand
for long-term care services. The fiscal year 2015 budget request includes a decrease
in funding for State Veterans Homes grants. How will the decrease in construction
funding impact the availability of beds for veterans seeking long-term care through
State Homes?
Response. The decrease in the FY 2015 budget for funding State Veterans Home
construction grant applications is projected to have a minimal impact. Although it
is not possible at this time to predict with certainty how the FY 2015 budget will
affect the number of new bed construction grant applications received, the two unfunded construction bed projects on the FY 2014 priority list were applications to
replace existing beds. Therefore, these two projects would not affect bed availability.
The current bed levels in the State Veterans Home program are such that occupancy rates average 85 percent. An occupancy rate averaging 85 percent indicates
that a significant number of nursing home beds throughout the State Veterans
Home program are consistently unfilled or unused.
As VA examined budgetary needs for Long-Term Services and Supports (LTSS),
the focus remained on anticipated shifts in LTSS utilization from institutional to
non-institutional care. As enrollees have greater access to home and communitybased services, it is expected there will be less demand for long-stay facility-based
services. This not only applies to VAs own Community Living Centers and contracted nursing home programs but to State Veterans Nursing Home programs as
well.
Transportation
Question 116. VA has several transportation programs, including the Veterans
Transportation Service (VTS), beneficiary travel, and numerous pilot programs that
are supported through the Office of Rural Health.
A. How does VA track all funding utilized to provide for the transportation of veterans to VA facilities?
Response. Funding for transportation of Veterans comes from several sources depending on the program utilized. For VTS, VHAs CBO and Office of Rural Health
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partner to provide funds to the VA facilities. Funds are tracked by the respective
programs through the dispersal process and also at the facilities by using specific
budget object codes and fund control points. Funding for the Beneficiary Travel program is part of the individual facility budget and is also tracked at the local level
by use of budget object codes and fund control points, and nationally via the VHA
Support Service Center.
B. What metrics does VA have in place to ensure that these programs and pilot
programs are not duplicative?
Response. VTS has a well-established collaborative partnership with VHAs Office
of Rural Health. VTS and the Office of Rural Health meet on a monthly basis to
discuss joint efforts and to consider all aspects of shared projects, including expansion/deployment of program functions, programs interaction and coordination of efforts. This process is defined in a Memorandum of Understanding between the programs that includes several features to guarantee non-duplication and enhanced collaboration at the facility level. These features include:
Joint review of all medical center and VISN submissions/applications for participation and requests for funding to both programs;
An identified methodology for comprehensive planning, identifying locations for
joint funding and the funding formulas;
Specific agreements regarding sustainment funding; and
Specific metric reporting elements and a metric reporting system.
Medical Support and Compliance
Question 117. The Medical Support and Compliance appropriations account provides funding for the management, administration, and security of the more than
1,750 facilities throughout VHA. The VA medical centers and Other Field Activities
subaccount is projected to decrease by $147 million or 3.7 percent between fiscal
year 2014 and fiscal year 2015 and increase by $177 million or 4.7 percent between
fiscal year 2015 and fiscal year 2016. The VA medical centers and Other Field Activities subaccount supported 36,977 FTE in 2013.
A. What accounts for the $147 million decrease between fiscal year 2014 and fiscal year 2015?
B. What accounts for the $177 million increase between fiscal year 2015 and fiscal
year 2016?
C. What is the estimated FTE for 2014, 2015, and 2016?
Response. Total Medical Support and Compliance obligation estimates for FY
20142016 take into consideration anticipated changes in FTEE levels; travel and
transportation of persons; rent, communications, and utilities; printing and reproduction; contractual services; supplies and materials, equipment; and, lands and
structures based on past history and future requirements. Increases in FY 2015 and
FY 2016 represent for the most part inflationary increases. Once those obligation
estimates are determined, VA maintains the same proportion as reflected in the latest actual available (2013 actual for purposes of the FY 2015 Congressional submission) (see Percent of Overall Medical Support and Compliance Staffing by Function
Table). VHA is undertaking an analysis of staffing levels and overall resources necessary to support the delivery of medical care. This analysis includes both central
and field activities and may result in a shift in funding allocations among activities.
VA has already assumed a total reduction of 1,289 FTEEs in 2015 compared to
2014. Please refer to the table below.
Percent of Overall Medical Support and Compliance Staffing by Function

Description
VAMCs and Other Field Activities ..........................................................................

VISN Headquarters .................................................................................................
VHA Central Office .................................................................................................
Consolidated Patient Account Centers ..................................................................
Office of Informatics and Analytics .......................................................................
Health Administration Center ................................................................................
Employee Education Service Center .......................................................................
VHA Service Center ................................................................................................
Health Resource Center .........................................................................................
Health Eligibility Center .........................................................................................
Consolidated Mail Outpatient Pharmacies ............................................................
National Center for Patient Safety ........................................................................
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2013
2014
2015
2016
65%
3%
12%
5%
4%
4%
1%
4%
1%
1%
0%
0%
65%
5%
10%
5%
4%
4%
1%
4%
1%
1%
0%
0%
64%
5%
11%
5%
4%
4%
1%
4%
1%
1%
0%
0%
64%
5%
10%
5%
4%
4%
1%
4%
1%
1%
0%
0%
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Question 118. The VHA Central Office subaccount is projected to increase by $12
million or 1.9 percent between fiscal year 2014 and fiscal year 2015 and increase
by $13 million or 2 percent between fiscal year 2015 and fiscal year 2016. The VHA
Central Office subaccount supported 1,680 FTE in 2013.
A. What accounts for the $12 million increase between fiscal year 2014 and fiscal
year 2015?
year 2016?
Response. The response to question 117 also applies to questions 118125.
Question 119. The CPAC subaccount is projected to increase by $5.7 million or 1.9
percent between fiscal year 2014 and fiscal year 2015 and increase by $6.4 million
or 2.1 percent between fiscal year 2015 and fiscal year 2016. The CPAC subaccount
supported 3,082 FTE in 2013.
A. What accounts for the $5.7 million increase between fiscal year 2014 and fiscal
year 2015?
B. What accounts for the $6.4 million increase between fiscal year 2015 and fiscal
year 2016?
Question 120. The Office of Informatics and Analytics (OIA) subaccount is projected to increase by $4.9 million or 1.9 percent between fiscal year 2014 and fiscal
year 2015 and increase by $5.6 million or 2.1 percent between fiscal year 2015 and
fiscal year 2016. The OIA subaccount supported 634 FTE in 2013.
year 2015?
year 2016?
Question 121. The Health Administration Center (HAC) subaccount is projected
to increase by $4.2 million or 1.9 percent between fiscal year 2014 and fiscal year
2015 and increase by $4.7 million or 2.1 percent between fiscal year 2015 and fiscal
year 2016. The HAC subaccount supported 1,055 FTE in 2013.
year 2015?
year 2016?
Question 122. The Employee Education Service Center (EES) subaccount is projected to increase by $1.3 million or 1.9 percent between fiscal year 2014 and fiscal
fiscal year 2016. The EES subaccount supported 370 FTE in 2013.
year 2015?
year 2016?
Question 123. The VHA Service Center (VSC) subaccount is projected to increase
by $4.7 million or 1.9 percent between fiscal year 2014 and fiscal year 2015 and increase by $5.3 million or 2.1 percent between fiscal year 2015 and fiscal year 2016.
The VSC subaccount supported 2,489 FTE in 2013.
year 2015?
year 2016?
Question 124. The Health Resource Center (HRC) subaccount is projected to increase by $0.9 million or 1.8 percent between fiscal year 2014 and fiscal year 2015
and increase by $1.1 million or 2.1 percent between fiscal year 2015 and fiscal year
2016. The HRC subaccount supported 729 FTE in 2013.
year 2015?
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year 2016?
Question 125. The Health Eligibility Center (HEC) subaccount is projected to increase by $0.9 million or 1.9 percent between fiscal year 2014 and fiscal year 2015
and increase by $1 million or 2.1 percent between fiscal year 2015 and fiscal year
2016. The HEC subaccount supported 265 FTE in 2013.
year 2015?
year 2016?
Medical Facilities
Question 126. The Medical Facilities account provides for the operations and
maintenance of VHA facilities. The Engineering and Environmental Management
Services subaccount is projected to decrease by $23.3 million or 4.3 percent between
fiscal year 2014 and fiscal year 2015 and increase by $19 million or 3.7 percent between fiscal year 2015 and fiscal year 2016. This subaccount supported 3,182 FTE
in 2013.
A. What accounts for the $23.3 million decrease between fiscal year 2014 and fiscal year 2015?
year 2016?
C. What is the estimated FTE for 2014, 2015, and 2016
Response. Total Medical Facilities obligation estimates for FY 2014-FY 2016 take
into consideration anticipated changes in FTEE levels; travel and transportation of
persons; rent, communications, and utilities; printing and reproduction; contractual
services; supplies and materials, equipment; and lands and structures based on past
history and future requirements. Once those obligation estimates are determined,
VA maintains the same proportion as reflected in the latest actual available (2013
actual for purposes of the FY 2015 Congressional Submission) (see Percent of Overall Medical Facilities (Excluding Non-Recurring Maintenance Table). FY 2015 Estimate for Non-Recurring Maintenance (NRM) reflects the FY 2015 Advance Appropriation level. FY 2016 NRM estimate of $460.6 million continues the same program
funding level as projected in FY 2015. VA has already assumed a total reduction
of 823 FTEEs in 2014 compared to 2013. Overall FTEE level estimates for Medical
Facilities are 22,818 in 20142016. FTEE levels are subject to change. VHA is undertaking an analysis of staffing levels necessary to support the delivery of medical
care (estimated delivery date September 2014).
Percent of Overall Medical Facilities

(Excluding Non-Recurring Maintenance)
(Obligations)
Description
Engineering & Environmental Management Services ...........................................

Plant Operations and Leases .................................................................................
Transportation Services ..........................................................................................
Grounds Maintenance & Fire Protection ................................................................
Recurring Maintenance & Repair ..........................................................................
Operating Equipment Maintenance & Repair .......................................................
Environmental Management Service .....................................................................
Other Facilities Operation Support ........................................................................
Textile Care Processing and Management ............................................................
2013
2014
2015
2016
14%
31%
4%
2%
14%
12%
18%
1%
5%
13%
37%
3%
2%
13%
11%
16%
1%
4%
12%
42%
3%
2%
12%
10%
15%
1%
4%
12%
42%
3%
2%
12%
10%
15%
1%
4%
Question 127. The Plant Operations and Leases subaccount is projected to increase by $233.3 million or 15 percent between fiscal year 2014 and fiscal year 2015
and increase by $82.5 million or 4.6 percent between fiscal year 2015 and fiscal year
2016. This subaccount supported 1,369 FTE in 2013.
A. What accounts for the $233.3 million increase between fiscal year 2014 and fiscal year 2015?
B. What accounts for the $82.5 million increase between fiscal year 2015 and fiscal year 2016?
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Question 128. The Transportation Services subaccount is projected to decrease by
$5.9 million or 4.3 percent between fiscal year 2014 and fiscal year 2015 and increase by $4.8 million or 3.7 percent between fiscal year 2015 and fiscal year 2016.
This subaccount supported 1,140 FTE in 2013.
A. What accounts for the $5.9 million decrease between fiscal year 2014 and fiscal
year 2015?
year 2016?
Question 129. The Transportation Services subaccount is projected to decrease by
$5.9 million or 4.3 percent between fiscal year 2014 and fiscal year 2015 and increase by $4.8 million or 3.7 percent between fiscal year 2015 and fiscal year 2016.
This subaccount supported 1,140 FTE in 2013.
year 2015?
year 2016?
Question 130. The Ground Maintenance and Fire Protection subaccount is projected to decrease by $3.6 million or 4.3 percent between fiscal year 2014 and fiscal
fiscal year 2016. This subaccount supported 732 FTE in 2013.
year 2015?
year 2016?
Question 131. The Recurring Maintenance and Repair subaccount is projected to
decrease by $22.5 million or 4.3 percent between fiscal year 2014 and fiscal year
year 2016. This subaccount supported 3,309 FTE in 2013.
Question 132. The Non-Recurring Maintenance subaccount is projected to decrease
by $334 million or 42 percent between fiscal year 2014 and fiscal year 2015 and remain at $460.6 million for fiscal year 2016. This subaccount supported 121 FTE in
2013.
A. What accounts for the $334 million decrease between fiscal year 2014 and fiscal year 2015?
B. What is the estimated FTE for 2014, 2015, and 2016?
Question 133. The Operating Equipment Maintenance and Repair subaccount is
projected to decrease by $18.9 million or 4.3 percent between fiscal year 2014 and
fiscal year 2015 and increase by $15.4 million or 3.7 percent between fiscal year
2015 and fiscal year 2016. This subaccount supported 2,012 FTE in 2013.
Question 134. The Environmental Management Service subaccount is projected to
decrease by $28.7 million or 4.3 percent between fiscal year 2014 and fiscal year
year 2016. This subaccount supported 10,512 FTE in 2013.
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Question 135. The Textile Care Processing and Management subaccount is projected to decrease by $7.6 million or 4.3 percent between fiscal year 2014 and fiscal
fiscal year 2016. This subaccount supported 1,264 FTE in 2013.
year 2015?
year 2016?
NATIONAL CEMETERY ADMINISTRATION
Question 136. The fiscal year 2014 current estimate for Grants for Construction
of Veterans Cemeteries is $62.1 million; however, the budget estimate for fiscal
year 2015 was only $44.6 million, a difference of $17.4 million. The fiscal year 2015
request for the grant program is $45 million.
A. What led to the unobligated balance of $16.1 million that was left over from
fiscal year 2013?
Response. The Department of Veterans Affairs (VA) ability to obligate grant
funds depends in large part on a states readiness to proceed. Two projects experienced issues late in the Federal fiscal year that could not be resolved by the proposed suspense date. One project could not proceed as anticipated due to Environmental Assessment issues, and the other could not proceed due to timing of conveying the underlying land to the state. By the time the two projects were deferred
by the states, it was too late to re-allocate the funds to other projects. VA has committed the $16.1 million to other projects and plans to make awards this fiscal year.
B. Does VA expect a similar carryover into fiscal year 2015? If so, please provide
the amount and reasoning for the assumption.
Response. No, Department of Veterans Affairs does not anticipate a similar carryover into fiscal year 2015. However, because final grant awards are based on a
states readiness, a small amount of carryover each year is not unusual.
C. How many states have pending requests for state veteran cemeteries grants?
Please list the grant application by state, location, and priority status.
Response. The fiscal year 2014 Priority List (attached) has a total of 87 pending
grant requests for state and tribal cemeteries. These grant requests are identified
by priority groups 14:
Priority Group 1Projects needed to avoid disruption in burial service that would
otherwise occur at existing veterans cemeteries within 4 years of the date of the
preapplication. Such projects would include expansion projects, as well as improvement projects (such as construction of additional or replacement facilities) when
such improvements are required to continue interment operations.
Priority Group 2Projects for the establishment of new Veterans cemeteries.
Priority Group 3Expansion projects at existing Veterans cemeteries when a disruption in burial service due to the exhaustion of existing gravesites is not expected
to occur within 4 years of the date of the preapplication.
Priority Group 4Improvement projects for cemetery landscaping or infrastructure, such as building expansion and upgrades to roads and irrigation systems, that
are not directly related to the development of new gravesites. Operation and Maintenance Projects that address National Cemetery Administrations national shrine
standards of appearance are included in this group.
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149
Question 137. The fiscal year 2015 budget requests states: Internments in 2013
were 124,785 and are expected to peak at about 130,000 in 2017. Internments will
begin to decline gradually and expected to be about 126,000 in 2020.
A. Please provide the Committee with detailed information on the number of veterans whose families chose an inurnment (please breakdown between in-ground
inurnment and those urns placed in a columbarium) as compared to the number
who elected for an in-ground casket burial over the last five years.
Response.
2009
2010
2011
2012
2013
Full Casket ..........................................................................................

In-Ground Cremains ............................................................................
Columbaria ..........................................................................................
57,634
30,023
18,704
59,503
31,547
20,757
61,036
33,155
23,221
59,708
33,327
25,121
61,656
33,588
29,541
Total Interments .........................................................................
106,361
111,807
117,412
118,158
124,785
B. What are the projections for inurnments compared to in-ground casket burial
through 2020?
Response.
2014
2015
2016
2017
2018
2019
2020
Full Casket .....................................................

In-Ground Cremains ......................................
Columbaria ....................................................
61,800
32,500
31,400
61,900
33,600
32,600
61,700
33,200
34,300
61,900
32,700
35,400
61,500
31,800
35,500
60,100
30,900
36,800
59,700
29,800
36,600
Total Interments ...................................
125,700
128,100
129,200
130,100
128,800
127,800
126,100
C. Will an increase in the numbers of inurnments versus in-ground casket burial

affect VAs long-term projections on the need for additional land acquisition and construction? If so, please provide a detailed explanation.
Response. National Cemetery Administration (NCA) projects that the number of
inurnments versus in-ground casket burials will continue to increase for the foreseeable future; however, it is unlikely that this trend will affect the need for additional
land acquisition and construction. In fiscal year (FY) 2013, NCA conducted 60,742
in-ground burials in national cemeteries, which comprised 49.4 percent of total interments. NCA projects to conduct approximately 50,200 in-ground casket burials in
national cemeteries, comprising 45.5 percent of total interments in FY 2050. These
data illustrate both the continuing need for burial space at Department of Veterans
Affairs (VA) national cemeteries and the demand for in-ground casket burials as an
option for Veterans who choose interment in a national cemetery. Through the use
and continued development of land-saving features, such as pre-placed crypts,
columbaria, and memorial walls, NCA will maximize land use at national cemeteries and slow the rate at which new land may need to be acquired. However, the
demand for new land will continue for the foreseeable future to ensure that VA is
able to meet the burial needs of Veterans and their eligible family members.
Question 138. Arlington National Cemetery (ANC) has faced a number of management, infrastructure, and information technology challenges in the last five years.
The National Cemetery Administration (NCA) was called upon to assist the Department of the Army and ANC to fix the numerous issues that were discovered at the
cemetery. Many of these challenges have been resolved through the development of
new technology, including geospatial tools and other grave location applications. Has
NCA incorporated any of the new technology into its operations? If so, please detail
the technology and how it is being used.
Response. National Cemetery Administration (NCA) is pursuing several technologies to improve cemetery operations, ensure the accountability of remains, and
enhance the experience of visitors at Department of Veterans Affairs national cemeteries. NCA works continuously to upgrade existing information systems, such as
the Burial Operations Support System and the Automated Monument Application
System. NCA has implemented automation enhancements to these systems utilized
for critical processes, including scheduling of committal services, establishing
records of interment, and ordering and tracking delivery of headstones and markers.
NCA is also conducting pilot studies to integrate geospatial information technology to enhance documentation associated with the interment process and the
marking of graves. At Indiantown Gap National Cemetery, PA, employees are test-
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ing GPS technology to attach geographic coordinates to digital records of casket and
urn tags, and temporary and permanent gravesite markers. In a separate project,
NCA is utilizing architect engineers to survey existing gravesites at six cemeteries
to compile GPS information along with digital photographs of each headstone and
marker. NCA is assessing the potential for eventual nationwide adoption of such
processes to improve the accuracy of gravesite layout maps and records of interment; to support caretakers in the field with information immediately available via
mobile devices; and to enhance visitors ability to locate gravesites and obtain other
information concerning the history and features of national cemeteries. NCA plans
to adopt geospatial information technology with all interments that are conducted
at five new national cemeteries that are planned to open nationwide beginning in
2015.
Question 139. When burial requests are initiated with the National Cemetery
Scheduling Office, NCA personnel ask a number of questions regarding burial arrangements, including whether a veteran is ineligible pursuant to title 38, United
States Code (U.S.C.), section 2411. Please provide a list of all the questions that are
asked by NCA to funeral homes, family members, and other individuals who have
contacted NCA for burial.
Response. The National Cemetery Administration employee asks a series of questions during the initial interview process to establish a record of interment and eligibility for burial. The following points guide the gathering of information from families or their representatives who call to schedule a burial in a Department of Veterans Affairs national cemetery.
1. National cemetery selected.
2. Determine if this is a first interment using the burial eligibility of a Veteran
or a subsequent interment (Veteran or dependent is already interred).
3. If subsequent interment, name of the decedent who is already interred.
4. Decedents full name, gender, SSN, date of death, date of birth, and relationship to Veteran.
5. Contact information (Funeral Home, directors name, phone number, and email
address).
6. Next of Kin information (name, relationship to the deceased, SSN, phone number, and address).
7. Determine if the decedent resided within 75 miles of the requested cemetery.
8. Zip code and County of decedent at time of death.
9. Type of burial (casket or cremation), casket size, liner size, urn size.
10. Marital status of Veteran.
11. If the spouse is a Veteran: Determine if a set-aside gravesite is requested.
12. Ask if there are adult disabled dependent children who may be eligible for future interment.
13. Determine military documentation to establish eligibility for burial.
14. Ask whether the decedent had ever committed a capital crime.
15. Ask whether the decedent had been convicted of a sexual offense for which
a minimum of life imprisonment was imposed.
16. Determine if the family has requested a service with military honors.
17. Ask if the family desires an emblem of belief on the headstone or marker; and
if so, what type.
VOCATIONAL REHABILITATION AND EMPLOYMENT
Question 140. The fiscal year 2015 budget request proposes a legislative change
to title 38, U.S.C., section 3697 to remove the annual funding limitation available
to provide contract vocational and educational counseling to individuals qualifying
under section 3697(A).
A. Please provide the Committee with the number of veterans who have participated in this counseling.
Response. The current VetSuccess on Campus contract for Chapter 36 vocational
and educational counseling support runs from July 2013 to July 2014.
Utilizing FY 2013 funds to date, there were 7,418 Veterans who participated
in contract Chapter 36 vocational and educational counseling, with an additional
2,218 referrals for this counseling currently in progress.
Utilizing FY 2014 funds to date, there were 339 Veterans who participated in contract Chapter 36 vocational and educational counseling, with an additional 262 referrals for this counseling currently in progress.
B. How many contractors have been used to provide the counseling under section
3697?
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Response. Utilizing FY 2013 funds to date, a total of 22 contractors have been
used to provide the counseling under section 3697. Utilizing FY 2014 funds to date,
a total of 10 contractors have been used to provide the counseling under section
3697.
C. How much funding was used in fiscal years 2013 and 2014 for the counseling,
and how much remained under the statutory funding cap each year?
Response. Section 3697 of title 38 U.S.C authorizes VA to use $6 million from the
RB account to pay for educational or vocational counseling services obtained by VA
by contract for Veterans applying for or receiving Education or VR&E benefits. In
FY 2013, over $5.2 million was obligated from the RB account for contract vocational and educational counseling, and approximately $0.8 million remained under
the statutory funding cap. Of the $5.2 million obligated, over $2.6 million has been
paid and we expect to pay invoices from the remaining $2.6 million. In FY 2014,
obligations to date total over $1.4 million, leaving a current balance of approximately $4.6 million available to provide contract vocational and educational counseling to individuals qualifying under section 3697(A).
Question 141. It is the Committees understanding that the Vocational Rehabilitation and Employment (VR&E) C-WINRS information technology system has faced
a number of problems that have lowered its effectiveness.
A. What steps is VR&E taking to mitigate these issues?
Response. VR&E Service has identified both business process changes and IT system enhancements to improve data capture and reporting capability within
CWINRS. These changes include streamlining the case status change movements
and expanding select data points.
B. What are the long-term plans to replace or upgrade the system?
Response. VR&E Service has developed the business requirements for case-management technology to replace CWINRS, (a case-management software application
named after the stations that collaborated to develop the original version:
Waco, Indianapolis, Newark, Roanoke, and Seattle). The business requirements
are currently being validated. The desired future system will better reflect the business and data reporting needs of the VR&E Program.
Question 142. The VetSuccess on Campus (VSOC) program has expanded to at
least 94 campuses over the last few years. The Committee has heard from academic
administrators, at participating schools, that VSOC counselors do not have set performance standards and they often provide services that are outside the scope of
services the program was originally designed for.
A. Please provide a list of schools that currently have VSOC counselors on campus, and what schools VA currently plans to expand VSOC to during fiscal year
2015.
Response. The VetSuccess on Campus (VSOC) program is currently at 94 campuses nationwide, with 79 VSOC vocational rehabilitation counselors. VA is committed to the VSOC program, and will continue to evaluate schools in 2015 for potential future participation in 2016. Attached is the list of VSOC sites in alphabetical order and state.
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B. What performance measures are currently used to determine the effectiveness

of VSOC counselors?
Response. To address the specific duties of a VSOC counselor on campus, separate
performance standards were developed and implemented for FY 2014.
VBAs Office of Field Operations notified VBA ROs of the national performance
standards for VSOC counselors. These performance standards highlight academic
outreach activities, including those for Veterans on academic probation. Other performance factors include timeliness of Chapter 36 vocational and educational counseling, entitlement determinations, customer service, and accuracy. The performance
standards include the following elements:
Element 1: Production/outcomes identified as new student contact rate, outreach activities, and academic probation.
New student contact rate: 80 percent of new Veterans on campus contacted during the first semester of attendance
Outreach activities and events: 12 VSOC related activities per year
Academic probation outreach activities: Outreach to 95 percent of Veterans and beneficiaries on academic probation
Element 2: Timeliness of claims processing
Chapter 36 timeliness: average of 30 days
Days to entitlement decisions: average of 40 days
Element 3: Quality/accuracy of work
VSOC vocational rehabilitation counselor accuracy (85 percent)
Element 4: Customer service
VSOC counselors will maintain professional, positive, and helpful relationships with internal and external customers by exercising tact, diplomacy, and cooperation. Performance demonstrates the ability to adjust to
change or work pressures, to handle differences of opinion in a professional
manner, and to follow instructions conscientiously. As a division member,
the VSOC counselor will contribute to the success of the VetSuccess on
Campus mission by supporting school certifying and campus officials, as
well as Veterans and dependents from neighboring schools.
Element 5: Program and data integrity
The VSOC counselor will complete all counseling actions and documentation (both written and computer entry) in compliance with VBAs program
directives.
Element 6: Cooperation and organizational support
The VSOC counselor understands the agency mission and supports efforts to improve the work units performance through positive interaction
with others.
Displays professionalism and treats school officials, Veterans, and employers with courtesy and respect.
155
Cooperates with supervisors, school officials, volunteers, and work-study
students to accomplish work objectives and enhance efficiency.
Recognizes the importance of teamwork and is sensitive to the contributions of others.
Communicates, shares ideas, and demonstrates respect for differing viewpoints.
Participates in cross-functional teams to address shared challenges, facilitate better communication, and achieve agency goals.
C. Please describe in detail the supportive services a VSOC counselor is allowed
to provide veterans and what, if any, services are directly prohibited.
Response. Vocational Rehabilitation Counselors (VRC) are uniquely qualified, by
virtue of their ability to provide Veterans with information about and seamless access to VA benefits and services, to support those Veterans successful integration
into college and university campuses and support their individualized educational
goals, so they may persist, graduate, improve their life circumstances, and successfully live and thrive in the career field and community of their choice.
VSOC supportive services are specific in order to address the need of the Veteran,
but encompass the following main categories:
Adjustment counseling to resolve problems interfering with completion of education programs and entrance into employment
Vocational testing
Career and academic counseling (Chapter 36)
Expedited VR&E services
Support, assistance, and services to all Veterans eligible for VA benefits.
Question 143. A veteran qualifies for VR&E eligibility if they a have a VA serviceconnected disability rated at least 20 percent with an employment handicap, or
rated 10 percent with a serious employment handicap.
A. Please provide the numbers and percentages of all VR&E participants for each
of the five tracks by disability ratings.
Response. This data is not readily available. VBA is currently working to pull the
data. Once the data is available, we will provide it to the Committee.
B. Please provide a list of the most prevalent disabilities of those veterans qualifying for VR&E services who are rated 10 percent.
Response. VR&E Service has no reporting capability that captures disability, gender, age, or similar demographic information for VR&E program participants based
on their employment track or independent living status. VBA is working to obtain
this information. We will pass this information to the Committee when it becomes
available.
C. Once a veteran has received an entitlement decision and the veteran and
VR&E counselor are developing a rehabilitation plan, is the type of services considered based on what limitations the veteran faces directly associated with their disability or on what type of employment the veteran wants to pursue irrespective of
the disability?
Response. The mission of VR&E is to provide services to eligible transitioning Servicemembers and Veterans with service-connected disabilities and an employment
handicap to help them prepare for, find, and maintain suitable employment. Each
VR&E program applicant participates in a comprehensive evaluation with a professional Vocational Rehabilitation Counselor (VRC) to determine entitlement to services. The comprehensive evaluation includes an assessment of the Veterans educational and employment history and current interests, aptitudes, and abilities, as
well as the current and projected impact of the Veterans service-connected disabilities and other medical conditions on employability, to assist in identifying the Veterans rehabilitation needs.
Once the evaluation is complete and the Veterans rehabilitation needs are identified, the VRC will work with the Veteran to develop an individualized rehabilitation
plan. The plan takes into account the Veterans interests, aptitudes, and abilities,
as well as disability/medical considerations and labor-market factors likely to impact
successful employment. As the goal of VR&E program is to assist Veterans to overcome the effects of service-connected condition(s), the selected employment goal
must be suitable. Specifically, it must not aggravate the Veterans disabilities, it
must be stable, and it must be consistent with his or her pattern of abilities, aptitudes, and interests. While the VRC takes into account what the Veteran wants in
terms of vocational pursuits, VR&E focuses on the needs of the individual and the
disability impairments that may impede his or her success in a particular field.
D. How does whether or not a veteran plans to seek employment after completing
a course of rehabilitation factor into a counselors decision to approve a rehabilita-
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tion plan? If a counselor believes a veteran does not intend to pursue employment,
is there a prohibition against approving a rehabilitation plan?
Response. The mission of VR&E is to provide services to eligible transitioning Servicemembers and Veterans with service-connected disabilities and an employment
handicap to help them prepare for, find, and maintain suitable employment. The
majority of rehabilitation plans have an end goal of employment. A rehabilitation
plan is normally developed with the stated goal of employment, and the plan may
or may not include training. If a vocational goal/employment is not feasible at that
point for the Veteran, then a plan is developed to focus on activities of daily living
with desired outcome of achieving maximum independence for the Veteran.
Independent living plans may include access to community-based support services,
use of assistive technologies and accommodations, and independent living skills
training. When a Veteran successfully completes a plan of independent living services, the Veteran and the VRC will work together to determine if the Veteran has
achieved enough stability to consider pursuing employment.
Question 144. The fiscal year 2015 budget request describes the development of
a new VR&E Staffing Model that is scheduled for completion in 2014.
A. Please describe the new model and how it will assist VA in making staffing
decisions.
Response. The new RO staffing model for the VR&E program is based on factors
that include actual workload, type of work done by various positions (VRCs, Employment Coordinators, Program Support Specialists, etc.), and geographic locations
of ROs, out-based offices, and Veterans. The model will provide a more systematic
way to align staffing needs, personnel allocations, and FTE requests as part of the
budget cycle.
Expansion of the staffing model includes beta-testing and familiarization, adding
new requirements, training, and a user guide.
B. What are the key milestones and dates for completion of this model?
Response. Requirements have been developed, and a contractor is currently working on user-acceptance testing. The model is planned to be ready for deployment in
FY 2015.
Question 145. Please provide the Committee data on VR&E activities by regional
office, including but not limited to: 1) number of counselors at each office, 2) number
required at each office, 3) rehabilitation rate, 4) timeliness, 5) cases, and 6) veterans
served.
Response. The number of VRCs required is based upon the Office of Field Operations (OFO) RAM, which is a staffing model based on workload demands and performance. In addition to VRC FTE allocations, OFO also allocates VR&E contract
counseling funds to augment counseling services provided by VA employees. Station
allocations are made based on workload demands and may be adjusted throughout
the fiscal year to ensure coverage during workload surges and unexpected workload
influx, or to assist in transitioning while vacant positions are backfilled.
USA FY 2013 .................................................

Eastern Area (16 ROs) .................................
Baltimore .......................................................
Boston ...........................................................
Buffalo ...........................................................
Cleveland .......................................................
Detroit ............................................................
Hartford .........................................................
Indianapolis ...................................................
Manchester ....................................................
New York .......................................................
Newark ...........................................................
Philadelphia ..................................................
Pittsburgh ......................................................
Providence .....................................................
Togus .............................................................
White River Junction .....................................
Wilmington ....................................................
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Number of
Vocational
Rehabilitation
Counselors
Rehabilitation
rate
1,042
202
14
9
15
28
31
11
21
5
16
11
13
9
7
8
2
2
68.4%
68.9%
49.3%
62.7%
71.1%
63.6%
83.3%
76.6%
24.0%
88.8%
81.9%
71.1%
46.7%
73.7%
83.7%
5.0%
85.1%
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Days to
notification of
entitlement
determination
(timeliness)
42.3
32.9
83.5
38.3
47.1
51.6
35.9
45.8
52.2
46.4
43.1
39.8
40.4
31.5
35.8
46.3
43.6
Chapter 31
participants
Number of
Veterans served
(all Chapters)
135,815
29,889
2,073
1,415
2,125
4,779
4,354
1,643
3,401
716
2,078
1,823
2,044
945
641
956
597
299
140,452
30,592
2,156
1,426
2,595
4,795
4,363
1,646
3,403
719
2,118
1,834
2,062
963
642
970
599
301
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157
Southern Area (12 ROs) ...............................

Atlanta ...........................................................
Columbia .......................................................
Huntington .....................................................
Jackson ..........................................................
Louisville .......................................................
Montgomery ...................................................
Nashville ........................................................
Roanoke .........................................................
San Juan .......................................................
St. Petersburg ...............................................
Washington ....................................................
Winston-Salem ..............................................
Central Area (14 ROs) .................................
Chicago .........................................................
Des Moines ....................................................
Fargo .............................................................
Houston .........................................................
Lincoln ...........................................................
Little Rock .....................................................
Milwaukee ......................................................
Muskogee .......................................................
New Orleans ..................................................
Sioux Falls .....................................................
St. Louis ........................................................
St. Paul .........................................................
Waco ..............................................................
Wichita ..........................................................
Western Area (16 ROs) ................................
Albuquerque ..................................................
Anchorage ......................................................
Boise/Cheyenne .............................................
Denver ...........................................................
Fort Harrison .................................................
Honolulu ........................................................
Los Angeles ...................................................
Manila ...........................................................
Oakland .........................................................
Phoenix ..........................................................
Portland .........................................................
Reno ..............................................................
Salt Lake City ................................................
San Diego ......................................................
Seattle ...........................................................
Number of
Vocational
Rehabilitation
Counselors
Rehabilitation
rate
327
46
30
9
7
25
28
25
30
6
64
24
33
275
14
8
6
60
8
13
13
22
13
7
18
11
71
11
238
8
8
25
6
13
24
2
24
21
21
5
19
30
32
83.9%
74.7%
92.2%
77.3%
77.9%
85.2%
73.6%
70.3%
88.9%
84.4%
84.4%
78.4%
65.3%
73.1%
70.6%
57.0%
82.6%
83.2%
89.0%
32.1%
73.1%
69.0%
89.9%
80.3%
28.5%
84.3%
79.3%
93.8%
81.5%
91.3%
81.9%
72.2%
75.0%
80.4%
83.5%
66.3%
90.8%
83.6%
81.9%
71.9%
Days to
notification of
entitlement
determination
(timeliness)
Chapter 31
participants
Number of
Veterans served
(all Chapters)
40,077
5,303
3,127
756
1,118
2,615
3,883
2,760
3,295
750
9,530
2,868
4,072
33,334
2,258
1,501
497
7,463
774
1,592
1,598
2,442
1,631
867
2,203
1,519
7,870
1,119
32,515
1,312
791
4,597
900
1,258
4,284
176
3,660
2,741
2,560
1,005
1,883
3,296
4,052
41,195
5,809
3,131
759
1,128
2,616
3,891
2,814
3,572
761
9,578
2,870
4,266
34,509
2,268
1,501
497
7,506
774
1,614
1,610
2,826
1,635
870
2,209
1,533
8,540
1,126
34,156
1,337
792
4,609
902
1,266
4,355
176
3,711
2,749
2,573
1,034
1,909
4,661
4,082
41.2
30.6
40.0
41.3
39.5
35.9
56.9
39.7
39.3
37.3
37.0
35.5
38.4
38.5
29.1
39.7
38.6
24.3
28.2
46.3
34.6
30.4
37.9
38.0
47.6
21.3
47.1
54.6
34.2
39.9
66.3
40.6
33.8
43.7
43.3
57.7
42.2
41.6
38.6
61.9
FILIPINO VETERANS EQUITY COMPENSATION FUND
Question 146. Information in the fiscal year 2015 budget request discusses two ongoing lawsuits that could affect the Filipino Veterans Equity Compensation Funds
unobligated balance.
A. Please describe each lawsuit, and how they could potentially affect the unobligated balance.
Response. Both lawsuits challenge Department of Veterans Affairs (VA) administration of the Filipino Veterans Equity Compensation (FVEC) fund and, in particular, the ways in which VA verifies whether a claimant had the service required
by law.
Recinto v. U.S. Department of Veterans Affairs was brought by individual Filipino
Veterans alleging their claims were wrongfully denied because of reliance on faulty
records and by individual widows of Filipino Veterans challenging the statute on
constitutional grounds. The number of individual claims directly involved in this
case was small. However, any ruling that the Governments process or the statute
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itself is legally deficient could have conceivably expanded the scope of the program
in ways that would have been difficult to predict.
De Fernandez v. U.S. Department of Veterans Affairs is a putative class action
brought by three individuals and an organization seeking declaratory and injunctive
relief. The suit principally alleges that VA relies on faulty records and unjustified
loyalty challenges to wrongfully deny legitimate claims. If a class were certified
and plaintiffs were successful, plaintiffs would likely ask the court to force VA to
re-adjudicate all denied FVEC claims under new procedures crafted by the court.
Veterans Benefits Administration projects that the end of fiscal year 2015 unobligated balance for the FVEC Fund will be $55.4 million.
B. Does VA have a timeline for when the lawsuits will be resolved? If so, please
provide it to the Committee.
Response. Recinto has been fully resolved. The case was dismissed by the district
court, and the dismissal was affirmed by the United States Court of Appeals for the
Ninth Circuit. Recinto v. U.S. Department of Veterans Affairs, 706 F.3d 1171 (9th
Cir. 2012). Plaintiffs petitioned the United States Supreme Court for certiorari. The
Court denied the petition on October 7, 2013.
The district court dismissed De Fernandez for lack of jurisdiction, relying on the
Ninth Circuits holding in Recinto that district courts lack subject-matter jurisdiction over veterans benefits claims. The plaintiffs appealed this case to the Ninth
Circuit, and the parties completed briefing in September 2013. We are currently
awaiting oral arguments to be scheduled for this case. It is possible the appeal may
be resolved within the next 12 months, depending on when the court schedules oral
arguments and issues a decision.
Question 147. The fiscal year 2015 budget request for the Filipino Veterans Equity Compensation Fund indicates that 333 Notices of Disagreement (NODs) have
not been resolved. The estimate for fiscal year 2015 is that $55.4 million in unobligated funds will remain at the end of the fiscal year.
A. When does VA believe the remaining 333 NODs will be resolved?
Response. The 333 appeals pending were as of September 2013. Currently, 130
Filipino Veterans Equity Compensation (FVEC) appeals are pending.
64 pending at the Manila RO, of which 33 are at the NOD and substantive appeal stages and 31 remanded by the Board of Veterans Appeals (Board) for further
development.
56 pending at the Board.
10 pending at other ROs for travel board hearings.
The majority of the 64 appeals pending at the Manila RO are awaiting service
verification, hearings, or a reply to the Decision Review Officer election letter. The
Manila RO regularly provides the National Personnel Records Center (NPRC) a list
of all pending requests for service verification. Follow ups are completed via email
and are faxed to NPRC when necessary. Additionally, FVEC appeals are given priority in the scheduling of hearings. Some of the hearings are coordinated with the
nearest RO where the appellant resides in the United States. Typically, the appeals
at the Manila RO are resolved or certified to the Board in 30 to 60 days. This is
dependent upon receiving documents from NPRC and can be extended if the claimant submits additional documents for review.
B. Once the remaining NODs are dispensed with, when will VA close the account
and remit the unobligated balance?
Response. We anticipate that VA will close the FVEC Fund account once all activities are complete. In FY 2010, Congress provided authority to transfer up to $67
million in unobligated balances from bid savings from the Major Construction account in section 901, Public Law 111212. Any remaining funds will be returned to
the Major Construction account for obligations as authorized by law.
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RESPONSE
TO
POSTHEARING QUESTIONS SUBMITTED BY HON. JERRY MORAN

TO
Rural Health and Joint Medical Facility Projects

Question 148. Secretary Shinseki, will you please provide analysis or report material you have received regarding the expansion of Project ARCH? What are the recommendations from staff within the VA, the Office of Rural Health and VISN 15
on the future construct of ARCH? Do you intend to make a decision about the future
of ARCH before the authority expires in September 2014?
Response. Project ARCHs congressional authority expires August 29, 2014. Section 402 of Public Law 110387 allows the Secretary to make recommendations regarding the pilot program, including if the pilot program should be made permanent.
In preparation for the expiration of the Congressional authority for Project ARCH,
VHAs CBO and Office of Rural Health are leading an integrated project team to
review options for providing health care for rural Veterans. The team is preparing
recommendations for senior leaderships consideration.
Additionally, VA is working diligently to ensure Veteran access to care is not interrupted when Project ARCH concludes. VHAs PC3 program will be available to
rural Veterans to help bridge this gap.
Under PC3, VHA has contracted with Health Net Federal Services and TriWest
Healthcare Alliance to develop a network of providers to deliver covered care. This
will provide eligible Veterans coordinated, timely access to specialty care through
a comprehensive network of non-VA providers who meet VA quality standards when
VA cannot readily provide the specialty care in-house due to geographic inaccessibility, lack of available specialists, and other factors. PC3 contracts have been
awarded in six regions.
VA envisions the integration of PC3 will perpetuate increased access for Veterans
in distance-challenged areas, provide quality health specialty care within all applicable VISN locations, and systematically reduce cost over time to ensure Veterans
have accessible health care closer to their homes.
Question 149. Secretary Shinseki, will you please provide metrics and data to ascertain how many veterans, across all VISNs, are receiving referrals for chiropractic
care? Please describe the referral process, step by step and approximate wait time
associated with the referral process.
Response. The number of unique patients receiving chiropractic care on-station
and through non-VA care for FYs 2012, 2013, and 2014 year-to-date is provided in
the first tab of the attached spreadsheet.
It is VA policy that access to chiropractic care, through consultation from either
the patients primary care provider or another VA clinician providing care for the
condition for which chiropractic care may be helpful, is consistent with the facilitys
policy and practice for all other specialty care access. Additional requirements or authorizations are not to be placed on referral for chiropractic care at a VA facility
or through the outpatient non-VA care program.
Consistent with the same process for all medical care, when a VA provider places
a referral for chiropractic care, a designated staff member reviews the referral for
clinical appropriateness. If additional information is needed or if the referral appears not suited for the chiropractic clinic, the referring provider is notified for additional follow up. If the referral request is appropriate, then a staff member is notified to contact the Veteran and schedule an agreed upon appointment. If the given
facility does not have an on-station chiropractic clinic, a designated staff member
from the business office reviews the referral to determine eligibility and notifies the
Veteran of follow-up steps.
Data on wait times for on-station chiropractic care for FYs 2012, 2013, and 2014
year-to-date are provided in the second tab of the attached spreadsheet. Wait times
for non-VA chiropractic care is not captured by VA and cannot be reported.
Outpatient Cube: Unique Patients for on-station (436) and non-VA (75) CHIROPRACTIC CARE
FY 2012 Actual
All Payment Locations .....

V01 ..................................
V02 ..................................
V03 ..................................
V04 ..................................
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FY 2013 Actual
FY 2014 Year-to-Date Actual
On-station
Non-VA
Total
On-station
Non-VA
Total
On-station
Non-VA
Total
23,834
1,462
2,364
171
385
9,059
410
182
11
244
32,893
1,872
2,546
182
629
25,829
1,712
2,499
38
304
10,105
246
306
17
370
35,934
1,958
2,805
55
674
16,844
1,131
1,705
59
124
7,548
179
274
20
332
24,392
1,310
1,979
79
456
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Outpatient Cube: Unique Patients for on-station (436) and non-VA (75) CHIROPRACTIC CARE
Continued
FY 2012 Actual
V05
V06
V07
V08
V09
V10
V11
V12
V15
V16
V17
V18
V19
V20
V21
V22
V23
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..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
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FY 2013 Actual
On-station
Non-VA
Total
445
569
682
2,128
960
813
975
835
1,189
288
3,569
1,420
767
868
1,012
2,407
554
52
165
126
1,222
619
13
509
188
638
348
92
115
325
1,247
820
591
1,150
497
734
808
3,350
1,579
826
1,484
1,023
1,827
636
3,661
1,535
1,092
2,115
1,832
2,998
1,704
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On-station
509
516
742
2,410
974
1,032
1,223
808
1,212
87
3,645
1,350
753
1,147
1,171
3,149
564
Sfmt 6621
Non-VA
106
155
30
1,323
447
10
530
322
673
371
44
109
999
1,600
802
248
1,404
FY 2014 Year-to-Date Actual

Total
615
671
772
3,733
1,421
1,042
1,753
1,130
1,885
458
3,689
1,459
1,752
2,747
1,973
3,397
1,968
On-station
Non-VA
Total
376
310
497
1,486
560
603
688
606
755
263
2,216
991
360
887
705
2,154
375
80
107
13
979
266
21
414
247
580
281
8
186
944
1,092
491
132
905
456
417
510
2,465
826
624
1,102
853
1,335
544
2,224
1,177
1,304
1,979
1,196
2,286
1,280
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All Facility .................................................................

V01 ............................................................................
V02 ............................................................................
V03 ............................................................................
V04 ............................................................................
V05 ............................................................................
V06 ............................................................................
V07 ............................................................................
V08 ............................................................................
V09 ............................................................................
V10 ............................................................................
V11 ............................................................................
V12 ............................................................................
V15 ............................................................................
V16 ............................................................................
V17 ............................................................................
V18 ............................................................................
V19 ............................................................................
V20 ............................................................................
V21 ............................................................................
V22 ............................................................................
V23 ............................................................................
36,399
1,983
2,707
64
593
592
648
611
3,737
1,086
1,445
1,926
946
3,208
257
5,379
3,498
765
1,110
1,830
2,977
1,037
FY 2012
41,643
1,972
2,641
174
765
892
725
651
5,655
1,198
1,819
1,582
1,125
3,205
287
5,100
3,494
682
2,581
2,227
3,775
1,093
FY 2013
22,526
1,049
1,089
96
635
436
392
351
2,817
639
962
533
512
1,476
685
2,441
2,256
195
2,662
1,347
1,533
420
FY 2014
Number of Consults
26,539
1,478
2,028
60
431
423
512
581
2,326
778
1,154
1,168
719
2,558
213
3,957
1,897
698
924
1,339
2,456
841
FY 2012
31,231
1,570
2,004
139
552
637
610
613
4,005
942
1,389
984
852
2,638
247
3,892
1,918
626
2,044
1,778
2,884
907
FY 2013
Unique Patients
19,776
985
1,034
88
543
355
377
341
2,677
580
856
480
493
1,357
657
2,287
1,370
194
1,948
1,283
1,491
380
FY 2014
50.6
61.1
31.1
29.3
33.1
65.5
36.4
61.2
55.2
33.0
32.7
28.3
40.0
106.7
58.0
33.4
62.3
32.9
35.1
49.3
66.8
24.8
49.0
37.9
29.6
50.1
39.8
59.3
56.4
57.7
67.2
37.7
24.6
25.1
30.6
73.7
77.6
32.6
49.1
33.6
74.0
43.8
62.8
30.9
FY 2013
35.2
39.3
27.4
50.6
28.4
30.9
44.8
28.1
40.1
28.7
26.3
26.7
29.7
38.9
38.8
33.3
24.0
19.5
48.2
36.2
58.3
14.6
FY 2014
Average Days to
Completed Consult
FY 2012
(436) CHIROPRACTIC CARE
99.6%
98.9%
100.0%
100.0%
100.0%
100.0%
100.0%
99.7%
99.5%
99.4%
99.7%
99.8%
99.3%
99.0%
96.5%
99.6%
99.9%
99.9%
99.9%
99.9%
99.7%
99.5%
FY 2012
95.2%
96.1%
96.2%
95.4%
98.6%
96.5%
95.2%
94.0%
94.7%
97.4%
96.0%
95.8%
94.6%
94.3%
90.6%
96.2%
95.7%
93.0%
93.2%
92.9%
94.6%
97.2%
FY 2013
66.1%
73.2%
84.1%
54.2%
64.6%
58.5%
58.7%
76.6%
54.2%
69.0%
70.2%
85.0%
82.4%
44.2%
44.1%
69.7%
81.5%
89.2%
65.6%
60.2%
60.2%
78.6%
FY 2014
Percent of Consults Completed
59.3
61.9
46.6
41.1
41.1
67.5
36.5
62.1
56.5
37.4
37.3
28.0
41.2
130.0
64.9
35.8
71.1
42.4
41.1
61.3
89.5
49.0
FY 2012
57.1
36.9
34.1
52.9
71.1
67.6
55.2
54.9
81.9
47.1
29.3
23.9
28.6
97.3
86.4
32.5
56.6
33.0
79.5
58.2
68.5
50.2
FY 2013
30.5
30.5
24.3
41.1
38.1
23.1
42.0
22.5
39.4
26.1
23.6
20.0
22.1
27.8
26.8
23.8
22.0
14.0
40.2
29.6
43.9
21.5
FY 2014
Average Days to First Action
Consult Cube: Number of Consults, Unique Patients, Average Days to Completed Consult, Percent of Consults Completed, Average Days to First Action
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Question 150. Secretary Shinseki, what intentions, if any, do you have to make
certain chiropractic care referrals are streamlined for our veteran population? What
specifically has been done to increase veterans access to a broader range of chiropractic services?
Response. VA has undertaken several steps to ensure appropriate access to chiropractic services for Veterans. Considering the rates of chiropractic services use at
VA chiropractic clinics and the U.S. population at large, VA has developed a population-based use model targeting 1.2 percent of a facilitys core unique patients. The
chiropractic national program office continues to provide guidance and support to
assist local VA facilities with the processes of implementing new chiropractic clinics.
To help improve the efficiency of non-VA chiropractic services, a multidisciplinary
workgroup developed a Clinical Patient Record System template for non-VA chiropractic consults that has been deployed and is now in use. VHAs Office of Academic
Affiliations has also established a pilot chiropractic residency training program
aimed at preparing graduates to better serve VA and the Nation.
Question 151. Secretary Shinseki, what steps are being taken or what plan has
been developed to address physician recruitment in rural areas and the consequent
extensive periods without physician care? Does the VA have a recruitment policy or
framework for rural areas? Is this something the Office of Rural Health is given the
opportunity to develop and the budget to carry it out?
Response. VHA markets directly to physicians for rural locations through its partnership with National Rural Recruitment and Retention Network (3RNet), a national network of non-profit organizations devoted to health care recruitment for underserved and rural locations. Through this partnership, VHA has access to a robust
database of candidates especially interested in, and leveraged against, rural vacancies. National recruiters routinely post VHA practice opportunities on 3RNets career page. In addition, 3RNet annually dedicates the month of November to Veteran
health care awareness by making VHA its featured employer for the month. In FY
2013, national recruiters increased recruitment of Veteran physicians by 43 percent
of which 24 percent were for rural or highly rural facilities.
Additionally, VHAs Office of Rural Healths goal is to develop innovative methods
to identify, recruit and retain health care professionals in rural and highly rural
communities. The Office of Rural Health has made significant investments to
strengthen the rural VA provider workforce and continuously seeks to understand
current and future rural provider workforce needs. Research shows that exposing
students to rural health care during medical or health professions school is an effective way to recruit providers to rural areas.
In FY 2013 and so far FY 2014, VA invested more than $15 million to support
rural provider training and continuing education initiatives to include:
Rural Health Training Initiative (RHTI)This pilot program between the Office
of Rural Health and the Office of Academic Affiliations increases rural health care
workforce recruitment by providing opportunities for medical students and other
health professions trainees to receive clinical training at rural health care sites.
Launched in the fall of 2012, RHTI funds 7 projects where more than 260 clinicians
have trained at 22 VHA rural sites of care.
VA Geriatric Scholars ProgramThe Office of Rural Health supports a successful
program to train clinicians at rural VA facilities in the most current practices in
geriatric care. In FY 2013, this program served all 21 VISNs, including 185 facilities
and 1,356 staff.
Specialty Care Access NetworkExtension for Community Healthcare Outcomes
In FY 2013, the Office of Rural Health provided funds to expand this already successful program that uses telehealth technology to provide specialty care consultation, clinical training, and clinical support from urban-based specialty care teams
to over 100 rural VA providers at 40 rural facilities so that they can manage patients with chronic conditions closer to home. Providers trained included primary
care physicians, nurse practitioners, and social workers. The Office of Rural Health
is expanding this program in FY 2014 to up to 19 additional sites.
Womens Health Provider TrainingThe Office of Rural Health has provided
funding to support the training of rural primary care providers in womens health
care topics.
Rural Provider and Staff Training Initiative (RPSTI)New in FY 2014, RPSTI
funds 21 VHA clinical sites serving rural Veterans to implement locally based, innovative training and educational programs for health care providers and clinic staff
on topics ranging from palliative care and dementia to polypharmacy and substance
use disorders.
Question 152. Secretary Shinseki, the VA FY 2015 Budget Request referred to the
Dole VA and McConnell AFB Joint Facility in the context of: Several major con-
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struction projects that were included on the 2014 SCIP priority list were not scored
in FY 2015 as they did not pass SCIP 2015 validation process, or were pulled from
consideration in 2015. Was the Dole VA project pulled from consideration? If not,
please provide the steps, measures and relevant detail associated with the aforementioned validation process, to include analysis and data that substantiates the
submission by the Dole VA did not pass the SCIP validation process.
Response. The SCIP validation process is a multi-step effort to ensure projects are
fully conceived and based on the most rigorous application of data possible. Validation is done at both the action plan and business case level; action plan validation
review begins in early spring each year.
The FY 2015 SCIP validation process found that the Wichita projects business
case did not address critical validation concerns and, therefore, the project was not
scored or considered for FY 2015 funding. The scope of the project submitted was
not well-defined and lacked clarity concerning the Department of Defenses (DOD)
involvement in the project. The Wichita project was removed from consideration and
was not scored in FY 2015 because the final business case included:
1. A cost estimate with more than a 25 percent variance from the established VA
cost-estimating guidance;
2. Cost data for only one valid alternative was provided (major construction),
when a minimum of three of the five additional alternatives (major lease, contract
out, acquire an existing facility, VA/DOD collaboration, and renovation) are required; and
3. Cost estimates that conflicted with other supporting materials.
VA capital planning staff will work closely with the facility, DOD, and all stakeholders to improve the projects business case for consideration in the FY 2016
process.
Question 153. According to the VA FY 2015 Budget Request, DOD CPC members
participate actively in VAs SCIP evaluation process and assist in identifying possible locations that would support increased collaboration. Please explain the participation of DOD CPC members. How does the SCIP evaluation process differ
from the SCIP validation process? Did DOD CPC members have the opportunity
to assess and evaluate the Dole VA and McConnell AFB Joint Project in SCIP FY
2015, to include the numerous MOUs currently shared between Dole and McConnell? If not, why not? If so, what was their assessment and did it include a review
of current MOUs?
Response. DOD Construction Planning Committee (CPC) members do actively
participate in VAs SCIP process. DOD CPC and VA members share data each year
on facility space (excess space or need space), workload, population, and proximity.
This information is provided to all SCIP users before the start of the annual SCIP
process to complete their action plans. Key contacts lists by location for VA and
DOD planners are also provided so that they can easily reach out to each other and
work together in collaboration where potential opportunities exist.
One of the key components of each Veterans Integrated Service Networks (VISN)
action plan review is the Subject Matter Expert Teams (SMET) reviews. One SMET
focuses on DOD/VA collaboration, and each VISN is reviewed to ensure joint opportunities are fully explored and included in the VA long-range plan. In addition, DOD
CPC members attend the VISN action plan presentations to the SCIP Board and
can ask VISNs questions concerning DOD/VA joint opportunities.
The validation, scoring, and prioritization of business cases is accomplished by the
Department-wide SCIP Panel, which consists of senior staff from nine VA Administrations and Staff Offices. A project that increases sharing between DOD and VA
would receive prioritization credit in DODs collaboration sub-criteria. A project that
lowers or does not increase sharing would not receive prioritization credit. Additional information on Departmental criteria is found in response to question 154.
Question 154. According to the VA FY 2015 Budget Request, DOD collaboration
is one of the national criteria elements VA uses to evaluate, score, and rank its capital projects. How does the VA numerically value DOD collaboration in the overall
SCIP process and criteria? Currently, this element is one of four Departmental Initiatives and treated separately from major and supporting initiatives. Why? If
overlap occurs with major and/or supporting initiatives, how does that impact the
score? Please explain DOD collaboration linkages, overlap, and duplication to separate criteria elements, particularly best value solution and maximize efficiencies. For the Dole VA and McConnell AFB Joint Project, what was the numerical score for the land transfer by McConnell AFB as criteria for cost savings, best
value solution and maximizing efficiencies? For major initiatives, how are educational institution partnerships numerically scored and ranked in comparison to
other major initiatives?
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Response. The FY 2015 SCIP Decision Criteria with priority weights are provided
below.
FY 2015 SCIP Decision Criteria Weights

(sorted by Major Criterion)
Major Criterion
Priority
Weight
Sub-Criterion
Priority
Weight
Overall
Weight
Improve Safety and Security
0.324
Seismic ..............................................................................
Safety/Compliance (excludes Seismic) .............................
Physical and Building Security/Emergency Preparedness
0.437
0.345
0.218
0.142
0.112
Departmental Initiatives
0.216
Major Initiatives ................................................................

Supporting Initiatives .......................................................
DoD Collaboration .............................................................
Energy Standards ..............................................................
0.543
0.289
0.094
0.074
0.117
0.062
0.020
0.016
Fixing What We Have
0.200
Reduce Facility Condition Assessment Deficiencies ........

Other Gaps (self-defined) .................................................
0.770
0.230
0.154
0.046
Increasing Access
0.155
Utilization/Workload ..........................................................
Veteran Access to Services ...............................................
Internal Access to Services ..............................................
Wait Times ........................................................................
Support Structures (parking) ............................................
0.327
0.213
0.052
0.222
0.186
0.051
0.033
0.008
0.034
0.029
Right-Sizing Inventory
0.057
SpaceNew Construction/Renovation/Lease ...................

SpaceCollocation ..........................................................
SpaceDisposal/Reuse ....................................................
SpaceTelework ..............................................................
0.560
0.229
0.118
0.093
0.032
0.013
0.007
0.005
Ensure Value of Investment
0.048
Best Value Solution ..........................................................

Cost Saving Strategies .....................................................
0.657
0.343
0.032
0.016
The DOD collaboration sub-criterion of the 2015 SCIP decision model has an overall priority value of .020. This sub-criterion is separated from the Major Initiatives
(MI) and Supporting Initiatives criterion to emphasize the importance of these
projects, as it effectively results in those types of projects earning extra points that
non-VA/DOD projects cannot earn. If two decision sub-criteria were so similar as to
overlap, then a projects score would include a double-counted score. Depending on
how thoroughly the overlapping decision criteria questions were answered, the impact could range from no impact to significant because each sub-criterion is scored
as a separate element. Duplication in the decision model is avoided where possible.
DOD collaboration is one of 20 sub-criteria in the decision model, which are
grouped by their relationship to the major criteria. Addressing one sub-criterion
does not automatically result in points given to another sub-criterion. A project is
evaluated on how well each sub-criterion is addressed. For example, the project may
receive a high score for the DOD collaboration question based on the written answer
and supporting documentation demonstrating VAs and DODs mutual interest in
the project, and then score very low on the safety/compliance question because the
narrative answer does not demonstrate that the project will mitigate a known safety
violation or bring the medical center into compliance for a sited deficiency.
This type of project could earn points for the cost saving strategies question by
demonstrating how this project saves money by allowing VA to acquire land at no
cost. The effect of a no-cost land transfer would be factored into the Best Value Solution question as part of the Net Present Value (NPV) calculation of that alternative. For example, if the cost of the new construction option and the VA/DOD Collaboration option were equal except for the cost of land acquisition, the NPV for the
VA/DOD Collaboration project would be better than the new construction option.
The highest score in the Best Value Solution question can only be given to projects
where the chosen option has the best NPV.
Because the Wichita VA/DOD major construction project did not pass the business
case validation process, the project was not scored for the FY 2015 budget and planning cycle. There are no numerical ratings for this project.
The Major Initiatives for the FY 2015 budget and planning cycle are:
(1) Eliminate Veteran Homelessness;
(2) Improve Veterans Mental Health;
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(3) Perform Research and Development to Enhance the Long-term Health and
Well-Being of Veterans;
(4) Enable 21st Century Benefits Delivery and Services;
(5) Automate GI Bill Benefits;
(6) Build Veterans Relationship Management Capability to Enable Convenient,
Seamless Interactions;
(7) Enhance the Veteran Experience and Access to Health Care;
(8) Establish Strong VA Management Infrastructure and Integrated Operating
Model;
(9) Transform Human Capital Management (telework); and
(10) Transform health care delivery through health informatics.
Educational institution partnerships are not ranked in relationship to the MIs.
Question 155. According to the VA FY 2015 Budget Request, The VISN future
year potential list includes several potential future collaborative efforts, listing the
Dole VA and McConnell AFB Joint Project as one of six future collaborative efforts.
Will you please explain why the VA FY 2015 Budget Request promotes and identifies this joint project as a specific example of VA/DOD collaboration but does not
score or rank it in the same FY 2015 budget document? What is the rationale behind the decision to list a Wichita, KS joint project in VA collaboration with DOD
but remove it from consideration to attain resources to develop this joint project?
Response. Though the Dole VA and McConnell AFB Joint Facility was not scored
in the FY 2015 SCIP, it is listed in the SCIP long-range plan as a potential outyear major construction project. There is still an opportunity for future collaboration
between VA and DOD at the Wichita location. VA is working with local facility planning to staff to assist in developing their business case to be considered for funding
during the FY 2016 SCIP process.
Question 156. How will VAs proposed changes to allow transfers to/from VA capital accounts in support of joint Federal facilities lead to more joint projects, such
as the Dole VA and McConnell AFB Joint Project? Has the VA identified existing,
potential and planned projects that would utilize this new authority? Please provide
a list of those projects. Please describe the differences in VAs FY 2015 proposal on
transfer of funds from Sections 223, 224 and 8098 of the FY 2014 Omnibus Appropriations Act that provides for additional transfer of funds authority to the Joint
Department of Defense- Department of Veterans Affairs Medical Facility Demonstration Fund. Are major and minor construction projects currently considered in
the Joint Department of DefenseDepartment of Veterans Affairs Medical Facility
Demonstration Fund? If not, please recommend a legislative alternative that would
give the Medical Facility Demonstration Fund the authority to expend funds on
minor and major construction projects.
Response. VA has proposed changes to its authorization to allow the Department
to plan, design, construct, or lease shared medical facilities with the goal of improving access to, and quality and cost effectiveness of, the health care provided by the
Department and other Federal agencies (e.g., DOD) to their beneficiaries. The proposal would allow the Department to transfer and/or receive funds (major and minor
construction) to/from another Federal agency for use in the planning, design, and/
or construction of a shared medical facility. Currently, VA cannot build space to accommodate non-VA workload. It also cannot build on non-VA owned land without
specific authorization.
The VA proposal would also allow the transfer (from the Medical Facilities appropriation) or receiving of funds to/from other Federal agencies for the purpose of leasing space for a shared medical facility, after section 8104 authorization requirements have been met. In order to foster collaboration, VA also requested to amend
the definition of medical facility to include any facility or part thereof which is,
or will be, under the jurisdiction of the Secretary, or as otherwise authorized by law,
for the provision of health care services.
The potential VA/DOD collaboration locations provided in Volume 4 of the 2015
budget submission are the locations that would most likely have the highest potential for using this new authority. These include Wichita, Kansas, El Paso, Texas,
Fort Knox, Kentucky, Beaufort, South Carolina, San Antonio, Texas and Oakland,
California.
In contrast to VAs FY 2015 proposal on transfer of funds, Sections 223, 224 and
8098 of the FY 2014 Omnibus Appropriations Act, which provide for additional
transfer of funds authority to the Joint Department of DefenseDepartment of
Veterans Affairs Medical Facility Demonstration Fund, only allow for minor construction funds to be transferred to the Demonstration Fund to support operations
at the Captain James A. Lovell Federal Health Care Center at North Chicago. Im-
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plementing VAs proposed authorization changes would provide VA and DOD the
greatest potential for increase joint collaborative projects.
RESPONSE
TO
POSTHEARING QUESTIONS SUBMITTED BY HON. JOHN BOOZMAN

TO
Question 157. What process is the VA Office of Acquisition and Logistics (OA&L)
using to mitigate procurement risk associated with companies who are debarred,
meaningfully related to debarred entities, have criminal activity, are financially
stressed, and have other high risk characteristics?
Response. As part of the Office of Management and Budget Circular A123 Acquisition Assessment, OALC conducts extensive file reviews, one of the goals of which
is to assess the extent of compliance with the requirement to award only to responsible parties. File reviews include determining compliance with specific VA policies
established by OALC, such as:
VA Procurement Policy Memo (PPM) 201305, Determining Contractor Responsibility, dated August 12, 2013. This policy requires contracting officers to check the
exclusions in the System for Award Management before any transaction (award or
modification) is made with a contractor. The policy provides implementing guidance
in determining contractor responsibility. File reviews assess whether the required
contractor responsibility determination was made properly.
VA Information Letter (IL 001AL0902), Integrated Oversight Process (IOP),
dated June 19, 2009. The IOP policy requires procurement reviews of specific contract actions at various dollar thresholds, and the reviews are performed by contracting organizations of each Head of Contracting Activity (HCA) within VA.
OALCs A123 assessments and file reviews evaluate whether the IOP policy was
followed and to what extent.
Question 158. Is there anything you are doing to prevent fraud or improper payments post-award? (This question is relevant because the Senator has a history of
working on improper payment issues)
Response. To prevent fraud or improper payments, Department of Veterans Affairs continues to take the following actions:
Partners with Treasury to leverage the Do Not Pay (DNP) solution, which
matches payments monthly against the Public Death Master File (DMF) and the
Excluded Parties List System (EPLS)/System for Award Management (SAM);
Matches benefits payments against the Social Security Administrations Private
Death Master File before they are submitted to Treasury;
Compares vendors on our financial management system to the EPLS/SAM on
a daily basis; and
Performs recapture and recovery audits for our programs, which result in corrective actions to improve business processes and ensure compliance.
Question 159. Does the VA have a post award process that tracks contractor performance? If so, are there any metrics around the value of government data vs. commercial data sources for this purpose?
Response. VAs Policy for Past Performance reinforces the Federal Acquisition
Regulation requirements and requires use of the Contractor Performance Assessment Reporting System (CPARS), managed by the General Services Administration,
that generates status reports for their respective HCA. These include: Contract Status Reports, Ratings Metrics Report, and Processing Times Reports. These reports
provide a record, both positive and negative, on a given contractor during a specific
period of time. These reports are supported by program and contract management
data, such as cost performance reports, customer comments, quality reviews, technical interchange meetings, financial solvency assessments, construction/production
management reviews, contractor operations reviews, and performance evaluations.
These reports are used as a resource to ensure VA is awarding best value contracts
and orders to contractors that consistently provide quality, and on-time products
and services that conform to contractual requirements. To our knowledge, there are
no commercially available metrics which compare government data to commercial
data.
RESPONSE
TO
POSTHEARING QUESTIONS SUBMITTED BY HON. DEAN HELLER

TO
Question 160. When does the VA expect to fully deploy all components and subcomponents in VBMS across all VA Regional Offices so that all 56 will qualify as
electronic Regional Offices (eRO)?
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Response. Veterans Benefits Management System (VBMS) utilizes an agile development approach that allows the Veterans Benefits Administration (VBA) to continually build functionality to support claims processing in 12-week sprints. With continuous development, VBMS will allow the electronic distribution of workload on a
national level and assist in automating portions of the claims process. As of
June 2013, VBMS was fully deployed to all 56 regional offices (RO).
The Newark RO was chosen as the electronic Regional Office (eRO) pilot station
to simulate the future operating model of a paperless RO. This allows VBA to understand the operational differences that a paper versus electronic environment
poses. This also provides an opportunity for VBA to test additional initiatives to continue to understand the future state and impact of those initiatives in an electronic
environment. Although VBA does not have the resources to remove all active paper
claims folders from all ROs, the remaining ROs are naturally moving into a
paperless state and adopting lessons learned through the distribution of the electronic Standard Operation Procedures and the realignment of responsibilities of
clerical staff. As of April 9, 2014, almost 90 percent of VBAs rating inventory is
electronic. VBA has not established a timeline for full transition to eROs.
Question 161. What percentage of claims being submitted at the Reno VA Regional Office are fully developed claims?
Response. In FY 2013, 25.4 percent of claims received by the Reno RO were fully
developed claims (FDC). In FY 2014 through March, this increased to 39.5 percent.
Question 162. How has VA partnered with the Veteran Service Organizations
(VSOs) to encourage and assist veterans with filing fully developed claims?
Response. VBAs Benefits Assistance Service (BAS) has partnered with VSOs on
several programs in support of assisting Veterans with FDCs. VA ROs conducted
workshops for their local Veterans Service Organizations (VSO) partners on the
FDC program. Each RO has a very active partnership with their local VSO community and has representatives attend local VSO trainings and meetings to provide information on filing electronic FDCs. BAS also has ongoing bi-weekly meetings with
VSOs and monthly meetings with VSO executive leadership, at which FDC filing
and assistance are regularly discussed. An FDC Forum was held during the VSO
bi-weekly meeting on February 6, 2014. This forum allowed national, state, and
county VSOs to ask clarifying questions about the FDC program and inform VBA
where additional training in the field may be needed. Additionally, BAS provides
monthly FDC reporting to the Big 6 VSOs. These reports provide the total number
of FDC claims submitted to each RO and the number that have been removed from
the FDC program. Based on these reports, VSOs are able to ascertain which of their
offices require more training on FDC submissions. FDC claims subm4ission is addressed and encouraged during all VSO eBenefits training sessions. Finally, VBA
also began a new partnership with VSOs and other stakeholders known as the Community of Practice (COP). The COP seeks to reduce the compensation claims backlog for Veterans by increasing the number of FDCs filed by Veterans and their advocates. The Disabled American Veterans and The American Legion are founding
members, and The National Association of State Directors of Veterans Affairs is a
member. In August 2013, VA also welcomed William & Mary Law Schools Lewis
B. Puller, Jr., Veterans Benefits Clinic to the FDC COP. The Puller Clinic was the
first law school clinic in the Nation to join the FDC COP. VA consults with members
of the COP throughout the development and implementation of VAs plan to end the
backlog in 2015 to ensure best practices and their unique insights are incorporated.
Question 163. Does the DOD and VAs current agreement regarding the electronic
transfer of service treatment records also apply to service treatment records for
members of the reserve components of the U.S. Armed Forces?
Response. On January 1, 2014, the Department of Defense (DOD) ceased sending
VA paper Service Treatment Records (STR). An interface was implemented to automatically transmit STRs between DODs Healthcare Artifact and Image Management System and VAs VBMS in an electronic format. If a member of the Reserves
or National Guard did not serve on active duty on or after January 1, 2014, an automated request for electronic STRs is not generated. VA continues to manually request these STRs from DOD, and DOD sends the STRs back electronically. VA and
DOD are reviewing options to close this gap.
Question 164. Between January 1, 2013 and December 31, 2013, dependency
claims, which are not included in the VAs rating bundle for backlog, rose from
170,000 to 230,000. What is the VAs plan to ensure that non-rating related claims
are completed in as timely a manner as rating-related claims?
Response. VBA holds employees at all levels of the organization accountable for
performance. Objective measures and performance standards are used to determine
if our managers and employees are meeting or exceeding their job requirements.
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Performance of Veterans Service Representatives (VSR), Ratings Veterans Service
Representatives (RVSR), and Decision Review Officers (DRO) is tracked in a national work credit system that is aligned with individual performance standards (attached). Employees are evaluated based on quality of work, production, customer
service, workload management, cooperation, and organizational support.
VBA sets the standards for work to be completed based on the position and experience level of the employee. VBA performance standards are consistent for all
claims processors across the Nation. Performance credit for VSRs is weighted based
on the complexity of the action completed. For example, completing an initial letter
in response to a Veterans claim for benefits is weighted higher than a follow-up contact with a Veteran via telephone. RVSR work credit is weighted based on the complexity of the case and number of issues rated. For example, an RVSR on the special
operations team that rates a highly complex claim with nine medical contentions
will receive a higher weighted credit than a RVSR on the express team that rates
a claim with two medical contentions.
Question 165. What measurements does the VA currently use for the VBA claims
processors work credit system?
Response. VBA holds employees at all levels of the organization accountable for
performance. Objective measures and performance standards are used to determine
if our managers and employees are meeting or exceeding their job requirements.
Performance of VSRs, RVSRs, and DROs is tracked in a national work credit system
that is aligned with individual performance standards (attachments 1-3 follow). Employees are evaluated based on quality of work, production, customer service, workload management, cooperation, and organizational support.
Attachment 1
VETERANS SERVICE REPRESENTATIVE (VSR)
(Excludes PMC and PCT VSRs)
The VSR must consistently and conscientiously exercise sound, equitable judgment in applying stated laws, regulations, policies and procedures to ensure accurate information is disseminated to Veterans and accurate decisions are provided on
Standard
Quality of Work
Successful Level
GS7:

The accuracy rate for work produced during the evaluation
period equals or exceeds 93% (cumulative)
GS9:
GS10:
GS11:
Indicators
A random selection will be made of an average of 5 actions per month regardless
of number of contentions claimed. Quality of action taken on each contention will
be evaluated. The selection of actions, while random, must reflect an appropriate
mix of work performed by the employee throughout the month (i.e. not from a single
day or single week).
If a routine review of a VSRs work demonstrates the need for quality improvement, an expanded sample of an average of 10 actions per month will be reviewed
for quality purposes.
The ASPEN checklist to be used will mirror the STAR worksheet and will include
a component on systems compliance, which will be considered a substantive error.
ELEMENT 2TIMELINESS/WORKLOAD MANAGEMENT (Critical)
Timely processing of Veterans claims is of paramount importance, as it is highly
correlated with customer satisfaction. The VSR will operate in an efficient manner
processes.
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VSRs are responsible for the cycles/type of work respective to their assigned duties. If multiple timeliness sub-elements apply to a VSR (e.g. average days awaiting
award, non-rating, and corrective actions) they must meet the Fully Successful level
for all applicable sub-elements to be successful for the element.
Extenuating circumstances and notification to the employees supervisor will be
considered. An incident will not be called until after the first notification of noncompliance of the above standard.
Timeliness
Timeliness of Rating End Products (including EP 930 series)
Fully Successful
All grade levels must meet locally established timeliness requirements, which are
to be derived from end of year station targets.
The percentage of claims in each cycle pending over the locally established cycle
goal must align with station goals for percentage of claims greater than 125 days.
Management for each station sets goals.
Cycle Times
a.
b.
c.
d.
Average Days Awaiting Development

Average Days Awaiting Evidence
Average Days Awaiting Award
Average Days Awaiting Authorization
Timeliness of Non-Rating & Control End Products (i.e. EPs 600, writeouts, 800
series)
Fully Successful
All grade levels must meet locally established timeliness requirements, which
should be derived from station targets.
Timeliness of Direct Services (i.e. IRIS, Congressional Inquiries, etc.)
Fully Successful
All grade levels must meet locally established timeliness requirements, which
should be derived from station targets. There will be no more than 5 instances
where the VSR fails to meet established timeliness, or failure of employee to notify
their supervisor when cases cannot be worked within established timeframes and
reasons thereof.
Timeliness of Special Projects & Duties (i.e. Women Veterans Coordinators,
AEW Project, etc.)
Fully Successful
There will be no more than 3 instances of tasks not being worked within established timeframes, or failure of employee to notify their supervisor when cases cannot be worked within established timeframes and reasons thereof.
Timeliness of Corrective Actions
Fully Successful
There will be no more than 3 instances of failure to complete a returned corrective
action, or failure of employee to notify their supervisor when cases cannot be
worked, within three days of the case being returned to them for correction.
Workload Management
Fully Successful
All grade levels must manage their workload in accordance with locally established workload management plans. There will be no more than 2 instances where
the VSR fails to show compliance with established workload management procedures.
Local management will be responsible for creating and communicating a workload
management plan that will identify the types of work to be completed.
Indicators
VETSNET Operations Reports
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Fully Successful
VSRs process a minimum cumulative average number of outputs per day. Outputs
will be counted as follows:
Development (Initial Development, Subsequent Development, and Ready
for Decision including rating Eps, EP 930s, administrative decisions, appeals, non-rating Eps, and EP 600s).7
12 contention claim development (Initial Development, Subsequent Development, and Ready for Decision including rating Eps, EP 930s, administrative decisions, appeals, non-rating Eps, and EP 600s).5
Telephone development -.1
Process award/decision (generate award, clear end product).7
Authorize award.33
Note 1: Subsequent development includes any actionable item, which moves the
claim forward and is subject to quality review.
Note 2: Telephone development requires contact with claimant, representative, or
medical facility to further the development of the claim. Credit for telephone development may be taken in addition to development credit.
Note 3: VSRs performing Post-Determination authorization duties will receive an
additional .5 weighted action for more complex cases involving out of system payments or retroactive effective dates preceding 1982 (earliest generate line in
VETSNET).
Successful Level
GS7: 4
GS9: 5
GS10: 5.5
GS11: 6
Indicators
VOR
ASPEN
There will be no output element expectation for 90 days following the completion
of challenge training regardless of entry grade.
Duplicate credit will not be allowed for self-correction of a VSRs error.
Leave, union time, and special projects or assignments pre-approved at the discretion of the supervisor are considered deductible time. Unmeasured time, such as informal training, was considered in developing the successful level and is not reportable deductible time.
VSR will stay abreast of current laws and regulations, work processes, policies
our Veteran population.
Employees are encouraged to actively participate in self-developmental activities.
Performance for this standard will be mitigated when the VSRs supervisor has
not allotted sufficient time for VSR to complete training requirements or if the VSR
is not provided a schedule of available training and the deadline they are to complete.
It is the responsibility of supervisors to provide VSRs with a training schedule
in advance so they can complete their training requirements.
Successful Level
GS7/9/10/11: Timely completion of nationally mandated training hours to include
core requirements and mandated local training during evaluation period. Completes
mandatory training within assigned deadlines with no more than 1 violation during
evaluation period.
Indicators
TMS
with customers by exercising tact, diplomacy, and cooperation.
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effectively communicate in a courteous manner with customers during the personal
or telephone interview process.
Successful Level
GS7/9/10/11:
* A valid complaint or incident is one where a review by the supervisor, after considering both sides of the
issue, reveals that the complaint/incident should have been handled more prudently and was not unduly aggravated by the complainant. Disagreeing, per se, does not constitute discourtesy. Valid complaints or incidents will be determined by the supervisor and discussed with the employee.
Indicators
Verbal and/or written feedback from internal and/or external customers
Observations by a supervisor with the complaint documented
Attachment 2
RATING VETERANS SERVICE REPRESENTATIVE (RVSR)
(Excludes PMC and IDES RVSRs)
The RVSR must consistently and conscientiously exercise sound, equitable judgment in applying stated laws, regulations, policies and procedures to ensure accurate information is disseminated to veterans and accurate decisions are provided on
Fully Successful (Issue Based)
612 months:
1318 months:
1924 months:
Over 24 months:
The accuracy rate during the

evaluation period equals or

Indicator
A random selection will be made of an average of 5 end products per month regardless of number of issues decided. This includes completed cases and partial ratings to determine the accuracy of the originator. The selection of actions, while random, must reflect an appropriate mix of work performed by the employee throughout the month (i.e. not from a single day or single week).
If a routine review of a RVSRs work demonstrates the need for quality improvement, an expanded sample of 10 total end products per month will be reviewed for
quality purposes.
Once an error is found and recorded concerning a specific issue associated with
the claim (ex: effective date), no additional errors related to that issue should be
recorded (consistent with M214 under the Quality Review Structure for cascading
effect).
ELEMENT 2TIMELINESS (Critical)
Timely processing of veterans claims is of paramount importance as it highly correlates with customer satisfaction. The RVSR will operate in an efficient manner
processes.
RVSRs are responsible for the types of work respective to their assigned duties.
Extenuating circumstances and notification to the employees supervisor will be considered.
Timeliness of Workload Management (includes rating, non-rating and appeals)
Fully Successful
RVSRs must manage their workload in accordance with locally established workload management plans.
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There will be no more than 3 instances of RVSR specific duties not being completed within locally established timeframes, or failure of employee to notify their
supervisor when cases cannot be worked within established timeframes and reasons
thereof during the evaluation period. An incident will not be called until after the
first notification of non-compliance of the above standard.
Indicators
1
2
3
4
5
VETSNET Operations Reports (VOR)

Supervisory Assignments and Observation
Folder Aging Reports
VACOLS Reports

Processes a minimum cumulative average number of weighted actions on rating
related end products and the following: EP 930 series, statements of the case, supplemental statements of the case, claims certified to BVA, hearing decisions, EP
290, 600, 095, 070, 172, 165.
Weighted action credit will be given based on number of issues completed per the
following:
12 issues completed: .5 weighted action
34 issues completed: 1 weighted action
59 issues completed: 1.5 weighted actions
Each additional 5 issues completed will be given .5 weight actions (i.e. 1014
issues completed: 2 weighted actions; 1519 issues completed: 2.5 weighted actions;
2024 issues completed: 3 weighted actions; et cetera)
Fully Successful
1318 months: 2 weighted actions
Over 24 months: 3 weighted actions
* RVSRs on the Special Operations team will have an additional .25 weighted actions added
to their output for each claim worked meeting special operations criteria to account for the complexity of these cases.
Indicators
VOR
ASPEN
VACOLS Reports
* Duplicate credit will not be allowed for self-correction of an RVSRs error.
** Leave, union time, and special projects or assignments pre-approved at the discretion of the
supervisor are considered deductible time. Unmeasured time, such as informal training, was
considered in developing the successful level and is not reportable deductible time.

RVSR will stay abreast of current laws and regulations, work processes, policies
our veteran population.
RVSRs are encouraged to actively participate in developmental activities of self
and others. For example, this may include volunteering to conduct needed training,
mentoring and second signature reviews.
The RVSR will complete mandatory Core Technical Training Requirements
(CTTR) as outlined on a published training schedule and within specified deadlines.
It is the responsibility of supervisors to provide RVSRs with a training schedule
in advance so they can complete their training requirements. It is the responsibility
of the RVSR to complete all required training within established guidelines.
Performance under this element will be mitigated when the RVSRs supervisor
has not allotted sufficient time for RVSR to complete training requirements or if the
RVSR is not provided a schedule of available training and the deadline they are to
complete.
Fully Successful
Timely completion of nationally mandated training hours to include core requirements and mandated local training during evaluation period. Completes training
within assigned deadlines with no more than 1 violation during evaluation period.
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Indicators
TMS
Functions as a team member to enhance resolution of claims by work actions.
Maintains professional, positive, and helpful relationships with internal and external customers (to include fellow employees and all stakeholders) by exercising tact,
diplomacy, and cooperation.
effectively communicate in a courteous manner with internal and external customers (to include fellow employees and all stakeholders).
The RVSR provides information to veterans and claimants that is accurate, concise, complete and written in a non-adversarial, respectful manner that demonstrates courtesy and compassion. This information may be in the form of rating
decisions, written correspondence to claimants and other verbal communication with
claimants such as personal hearings.
Fully Successful
* A valid complaint or incident is one where a review by the supervisor, after considering both
sides of the issue, reveals that the complaint/incident should have been handled more prudently
and was not unduly aggravated by the complainant. Disagreeing, per se, does not constitute
discourtesy. Valid complaints or incidents will be determined by the supervisor and discussed
with the employee.
Indicator
Verbal and/or written feedback from internal and/or external customers. Observations by a supervisor with the complaint documented.
Attachment 3
PERFORMANCE PLAN DRO
ELEMENT 1QUALITY OF WORK
The DRO must consistently and conscientiously exercise sound, equitable judgment in applying stated policies to ensure accurate and timely decisions on compensation and pension benefit claims administered by the Department of Veterans
Affairs.
Successful Level: Accuracy rate during the evaluation period equals or exceeds
90%.
Indicators
An unbiased selection will be made of an average of five cases per month per employee. The cases selected will be reviewed [prior to concurrence by a second signature, if applicable] to determine the accuracy of the originator of the decision. Only
one error is counted per case reviewed. The errors will be called using the categories
identified on Attachment A below.
ELEMENT 2PRODUCTIVITY*
Processes a minimum cumulative average number of 3 weighted cases per day.
Cases will be counted for production purposes as follows:
1/2 case = deferred/supplemental development actions when no other action listed below is possible. This excludes sending/preparing a DRO election letter. This
credit is not limited to formal appeal cases and can include any case for which substantive review and deferred/development by a DRO is appropriate.
1/2 case = Informal conference held; case certified to BVA; preparation time for
a hearing; formal hearing held (the 1/2 case for preparing for a hearing should be
reported separately from the 1/2 case awarded for holding a formal hearing).
* Leave, union time, special projects or assignments pre-approved at the discretion of the supervisor, and 2nd signature reviews (of trainees only) are considered deductible time.
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1 case = SOC, SSOC or DRO decision (includes EPs 172/174/070) with less than
8 issues decided.
2 cases = SOC, SSOC or DRO Decision with 815 issues decided.
3 cases = 1623 issues rated; 4 cases = 2431 issues decided, etc.
Note:
1. Only one type of case credit can be taken at a time. For example, if a DRO
does a separate SOC and a rating, only one credit would be taken. The credit with
the greater weight should always be used. If separate decisions combine to eight or
more issues, this can be combined and 2 case credits taken.
2. The 1/2 case development credit may apply to cases where an NOD has not
been filed. To be applicable, the cases must have already had a decision made on
them, and brought to the DROs attention because of some conflict with the facts
or law as applied in the case. This would also apply to any cases assigned to the
DRO by VSC management based on the complexity/sensitivity of the case. This credit does not apply to routine rating development cases and, again, can only be
claimed exclusive of any other weighted action listed above.
3. The case credit review for an SOC [EP 172 or 174] should be taken per the
parameters in M214 Appendix C. Concerning formal hearings (EP 174), a full case
credit is only available if the formal hearing is actually held; otherwise, the only
credit available is the 1/2 case for preparation time, if applicable.
4. The term DRO decision is defined as any rating related to an appeal where
the DRO has made a favorable decision requiring some type of award action. Separate DRO decision and rating decision documents for the same issue are not required.
5. Weighted case credit for non-appeal cases is the same as the RVSR weights.
Successful Level: weighted cases per day (cumulative)
Indicators
Production reports
ELEMENT 3CUSTOMER SERVICE
with internal/external customers by exercising tact, diplomacy, and cooperation.
conscientiously. As a team member, contributes to the group effort by supporting fellow teammates with technical expertise and open communications and by identifying problems and offering solutions. Successful achievement in this element reflects support of all scorecard goals.
Successful Level: No more than 3 instances of valid complaints or incidents.
Indicators
Verbal and/or written feedback from internal and/or external customers. Observations by a manager with the complaint documented.
A valid complaint or incident is one where a review by the supervisor, after considering both sides of the issue, reveals that the complaint/incident should have
been handled more prudently and was not unduly aggravated by the complainant.
Disagreeing, per se, does not constitute discourtesy. Valid complaints or incidents
will be determined by the supervisor and discussed with the employee.
ELEMENT 4TIMELINESS
Works in a manner that supports and contributes to meeting established VBA
timeliness requirements.
At present the timeliness element is not officially measured. Methods are currently being discussed concerning accurate and equitable ways to measure appeals
timeliness. At that time, this element will be revisited.
ATTACHMENT A
Were all claimed issues addressed?

Were all inferred issues addressed?
Were all ancillary issues addressed?
Was effort to obtain all indicated evidence documented?
Was requested VA exam necessary & appropriate or was a necessary exam requested?
Was all evidence received prior to denying claim?
Was the grant or denial of all issues correct?
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Were there percentage evaluations assigned correct?
Was the combined evaluation correct?
Were the effective dates correct?
Was all of the applicable evidence discussed?
Was the basis of each decision explained?
[end of attachments 1-3]
VBA sets the standards for work to be completed based on the position and experience level of the employee. VBA performance standards are consistent for all
claims processors across the Nation. Performance credit for VSRs is weighted based
on the complexity of the action completed. For example, completing an initial letter
in response to a Veterans claim for benefits is weighted higher than a follow-up contact with a Veteran via telephone. RVSR work credit is weighted based on the complexity of the case and number of issues rated. For example, an RVSR on the special
operations team that rates a highly complex claim with nine medical contentions
will receive a higher weighted credit than a RVSR on the express team that rates
a claim with two medical contentions.
Question 166. The fiscal year 2015 VA Budget Submission for Major Construction
Projects for the Veterans Health Administration notes that there remained $13.8
million in unobligated funds for the Las Vegas VA Medical Center through September 30, 2013. What is the VAs plan for utilizing unobligated funds to improve
any inadequacies at the Las Vegas VAMC?
Response. As of March 31, 2014, $11.5 million remains unobligated. Currently, approximately $2.9 million is set aside to complete open contract issues on the original
construction project, which includes the remaining contingency for active contracts.
VA is examining potential enhancements to the Las Vegas VA Medical Center with
the remaining $8.6 million.
Question 167. What progress has the VA made in establishing a National Veterans Burial Ground in a rural area of Nevada?
Response. Department of Veterans Affairs (VA) is proposing to establish a national cemetery presence in highly rural areas where the Veteran population is less
than 25,000 within a 75-mile service area. The proposal targets those states in
which there is no national cemetery within the state open for first interments and
areas within the state that are not currently served by a state Veterans cemetery
or a national cemetery in another state. Elko, Nevada is one of the eight locations
in which VA intends to establish a national cemetery presence as part of VAs Rural
Initiative. This location will serve a population of over 4,000 Veterans currently
unserved by a Veterans cemetery burial option. Funding is available for the site selection process.
VA advertised for potential sites in September 2013, and then assembled a site
evaluation team to visit Elko, Nevada, in December 2013 to review all responses.
Because the results of that site evaluation tour yielded only marginally acceptable
sites, VA is currently placing another advertisement seeking additional sites and
will conduct further site selection visits after reviewing responses. VA is also collaborating with officials of the City and County of Elko and the U.S. Bureau of Land
Management to seek available land that meets VA requirements. Once VA identifies
preferred sites, it will proceed with due diligence studies on those sites to ensure
that they are fully developable.
Chairman SANDERS. Thank you very much.

Let me begin by picking up on a point that Members have raised
and you just discussed yourself. For the last several years, there
has been a loud concern about the backlog.
General Shinseki, when you came into your position, you announced a very ambitious goal, and that goal was to process all
claims in 125 days with 98 percent accuracy by 2015. Your goal
was to go from a paper system to an electronic system.
Can you or General Hickey give us some explicit information
about where you are in that process?
Secretary SHINSEKI. Certainly, Mr. Chairman. Let me just open,
and then I will turn to Secretary Hickey for the specifics.
First, I would say that no veteran should have to wait to have
their claims adjudicated, and we are committed to doing that as
quickly as we can. Hence, 5 years ago, we had no standard for
what was a backlog, so we established one at 125 daysevery
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claim, not an average, but every claim handled in 125 days or
lessand all of our work done at 98 percent accuracy. That has not
changed.
What you have seen over the last 3 years was a commitment to
do that by investing resources you provided to come up with an automation tool called VBMS, Veterans Benefits Management System. It has taken us time to design, develop, test, pilot, and make
sure we had a good platform that we could hang capability on as
we continued to improve it.
You have seen all of that over the last 3 years. We completed
fielding it in June 2013.
Chairman SANDERS. If I may, because I only have 5 minutes, I
just want tothe bottom line is you believe you are on path to
achieve the goal that you established?
Secretary SHINSEKI. We are on path to do that.
Chairman SANDERS. General Hickey, do you want to add anything to that?
General HICKEY. Just to say that we have taken 237,000 out of
inventory in a single year, and we have reduced the backlog by 40
percent in a single year. Our veterans are now waiting 117 days
less on average for a claim decision, and our quality in all those
decisions is up over 90 percent.
Chairman SANDERS. OK. Let me ask Dr. Petzel a question if I
might.
Dr. Petzel, within the VA and throughout our country, there has
been a concern that we overmedicate. The VA has done some cutting-edge work in terms of using complementary and alternative
medicine to treat a variety of problems.
My understanding is that you have launched what is called an
Opioid Safety Initiative in Minnesota. Can you tell us a little bit
about that and what you see in terms of the future regarding complementary and alternative medicine?
Dr. PETZEL. Yes, Mr. Chairman. Thank you for that question.
We have actually launched this across the entire system. All of
our medical centers are now participating in an opioid safety program, which entails five elements.
It is an opioid dashboard which elucidates high prescribers and
high users and then a process by which the users and the providers
are met with and treatment is discussed.
Two, every medical center has a pain clinic.
Three, every medical center uses the Stepwise pain process
which the VA developeda real revolutionary approach to using
the least risky alternatives in managing pain.
I think from your perspective, most importantly, we require right
now that every pain program offer at least one alternative medicine-process and that they develop within this year another alternative medicine program. So, acupuncture for pain is probably the
most common thing, and you will find that we have about 90 acupuncture programs around the country.
Chairman SANDERS. Are you finding veterans gravitating to
those types of therapies?
Dr. PETZEL. Absolutely. People want to use the least risky way
to manage their pain.
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I mean, this is something that they have come with in general
out of their experiences in combat, and it can be a terrible burden
for them. And, yes, they want to find ways without using opioids
or narcotics to manage their pain.
Chairman SANDERS. All right. My last question is for whoever
may want to answer it, and that is with the health care budget.
As I understand it, Mr. Secretary, the VA anticipates seeing an
increase of approximately 100,000 new patients in the coming year.
We are delighted that more veterans are accessing VA health care,
but I am concerned whether the 3 percent increase in medical care
in this budget will be sufficient to care for these new users, existing users, expand available services, and keep pace with all of the
issues that we have there.
Is that enough money? It sounds to me like it is not.
Secretary SHINSEKI. Mr. Chairman, I would tell you we have, for
several years now, been working with DOD to understand how our
patient load may change when they arrive at the point that they
are going to make a decision about downsizing.
I believe that decision has been made. We are working with them
now to understand the plan. So, this budget request is prior to that
plan being provided, but we continue to work that.
We believe we have in this budget anticipated what our needs
are going to be in 2015, but then, again, this will depend on what
the downsizing plan entails.
Chairman SANDERS. OK. I am going to go vote and will be back
as soon as I can.
Senator Brown, will you take over, and do we have anybody who
has voted yet?
All right. We think Senator Isakson will be back soon. He will
take over the Chair, and we will rotate back.
Senator Johanns.
Senator JOHANNS. I was just going to offer, Mr. Chairman. It
looked like I had taken control. [Laughter.]
Just joking. Just joking.
Chairman SANDERS. Do not be reckless.
[Laughter.]
Senator JOHANNS. Secretary, let me focus on capital improvements, if I could.
The fiscal year 2015 budget request is for $561.8 million. As I
understand the way that request is put together, it is actually for
four ongoing projects that are in some state of construction.
So, the first question I have on that is, does that 561.8 represent
a sufficient amount of money to get those projects to the finish
line? Are they done at the end of that, or do we see this again next
year?
Secretary SHINSEKI. Senator, the four construction projectsand
I will list them: Los Angeles, for seismic corrections; Long Beach
Mental Health and Community Living Center; Canandaigua, New
York, domiciliary outpatient facility, community living center; San
Diego, spinal cord and seismic deficiency. These are all projects
that are on the execution list under the major construction program for 2015.
Senator JOHANNS. My question, though, is, does the $561.8 million complete those projects this year?
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Secretary SHINSEKI. Yes, they do.*
Senator JOHANNS. It does.
Secretary SHINSEKI. Yes.
Senator JOHANNS. OK. The concern I have, I guess, is probably
going to be obvious here. $561.8 million checks the box on those 4
projects. As you know, we have been working our way somewhere
through the list in Nebraska, although I do not want to single out
Nebraska. There are a whole bunch of other States out there, many
of which are ahead of us.
What I am looking at is all of these projects. There has been an
estimateit is probably a pretty rough estimate-that $23 billion is
necessary to address what is on the waiting list; and if Omaha is
that far down the list, I can only imagine the problems ahead of
us.
Tell me how we can best put a process in place to address what
you are dealing with and what we are dealing with?
It is a lot of money. It would be very hard to come up with.
I do not think we would want some 20-some projects all going at
once. That stretches everybody pretty thin.
So, how do we move these projects in a more aggressive way?
Secretary SHINSEKI. I would say, Senator, we have done our best
to prioritize these projects so that at the very top are the safety
and security issues that we have to address for safety of employees
and veterans. And when we do that, of course, then you can see
an ordering.
Second, the priority would be to ensure that what we have today
is kept at a good standard. And therefore, for minor construction,
not just major but minor construction and nonrecurring maintenance, those funds, in addition to the $561 million you talked
about, we have $495 million for minor construction, another $460
million for nonrecurring maintenance. So, these other funds keep
us at a safe standard in the facilities we have today.
Our commitment is as we work toward getting to Omaha, for example, that what we have today in Omaha, the hospital there, will
be kept at a safe, functioning standard that veterans will see as
their hospital delivering high-quality care.
Senator JOHANNS. Yes, I see the work. I was just out at the medical center recently, and I saw the work. They were talking to me
about the minor construction that they are doing.
I always receive it as a bit of a mixed blessing. Yes, I want that
facility to be safe and do things for veterans; on the other hand,
no one is going to argue that that facility should have a long-term
future.
So, all these millions we are putting into these facilities across
the countryI just hope we are not chasing good money with bad
money, if you know what I am saying.
I am sure it is a dilemma for you.
There is a point at which the buildings have just served their
useful life.
Secretary SHINSEKI. We do have facilities that are underutilized
and are vacant, and with those, we do our very best to take them
down so we can husband resources that would ordinarily go on to
* Secretary Shinseki corrects this statement later in his testimony.
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some level of maintenance there, husband those resources to put in
new facilities where they are needed.
I would also say, Senator, besides our major, minor and nonrecurring maintenance, these projects, we also have a leasing program that is important to us which primarily does not come out of
the construction budget; it comes out of the medical care account.
It is a powerful tool for us to be able to provide, in communities
where community-based outpatient clinics may be needed, a lease
arrangement. We stand it up very quickly, and it provides the services needed; and we are not going through a long-term development
process.
I would add a sixth component here and that would be our telehealth/telemedicine capability. We have invested heavily in that.
So, not only do you see 151 medical centers and 820 communitybased outpatient clinics and 300 Vet Centers, they are all linked
through telehealth/telemedicine, especially important in rural areas
where travel and access are not what they need to be.
But, if we can provide in those communities a clinic where veterans can find access, even if we do not have a kidney expert there,
through our telehealth means, we can give them access to one.
So, when we are talking about the construction program, I like
to view it as access; that is, the walk-in access and how we link
this through technology, to provide the best quality care and try to
level the playing field here so that a veteran, no matter where they
live, will be able to enjoy the quality care we can provide.
Senator JOHANNS. We will continue this discussion. I am going
to head to the floor so I can cast my vote before they close it.
Thank you.
Senator ISAKSON [presiding]. Well, the rest of the team will be
back in a little bit. I just passed them while coming back, so, we
will have the whole complement of Members pretty soon.
Mr. Warren, did I understand it correctly that you are the information technology person?
Mr. WARREN. Yes, sir, I have that role.
Senator ISAKSON. Well, I am about to demonstrate that I am not,
but I have a question about that which I would like to get an answer to.
I have been reading out the VBMS, the Veterans Benefits Management System, and I understand it is fully deployed now from
the standpoint of being installed, yet it is not operational. Is that
right?
Secretary SHINSEKI. Senator, it is fully deployed, fielded, and was
completed last June, 6 months ahead of schedule. It is being used,
but it is not the only means of processing a claim today.
This is probably the big crossover year for us. We still have
claims in paper, and so the great workforce that we have is dribbling two basketballs at the same time. They have to be able to do
paper today because that is the legacy system, but every day less
paper, and sometime later this year it will be only digital, and they
have to do digital at the same time today.
So, it is functional, but we are not totally reliant on just VBMS
today.
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Senator ISAKSON. From what I read, I think there is about $44.5
million in the budget for the continued installation of that. Is that
correct?
Secretary SHINSEKI. Let me turn to Mr. Warren on that.
Mr. WARREN. The number is actually $137 million
Senator ISAKSON. OK.
Mr. WARREN [continuing]. Being requested in the 2015 budget,
and we would appreciate your support for that, sir.
Senator ISAKSON. And here comes my question that is going to
illustrate my IT ignorance, probably. It is said in here that you are
using an agile approach in terms of the installation and that you
are deploying different patches and that this will take some time
to complete. Would you tell me what kind of patches you are talking about or what they are referring to?
Mr. WARREN. Thank you for that question, sir.
Agile is an approach where instead of putting all your requirements together and then many years down the road you bring capability online, as the Secretary mentioned, the system has been
brought online, and every 90 days we add more capability, more
function, in the hands of the employees in VBA so they can keep
processing more.
So, it is an iterative process. Every 90 days, major functionality
gets deployed. In between the 90 days, if there are things we need
to adjust or tweak, we add that capability in as well.
So, high frequency, high cycle rate, making sure we are putting
capability on the ground so that the folks in VBA can drive ourselves to that outcome.
Secretary SHINSEKI. Senator, if I can try tohe is a techy person.
I am not either, so let me try to put it in our terms.
There are two ways to approach a large IT project, which do not
apply to the smaller IT projects. They are a little more manageable.
But, a large IT projectyou can wait to design the entire elephant and then try to field that whole thing at once. And what
sometimes happens is you will find something does not work in this
large project, and then it is difficult to find it because everything
is out there.
The agile approach that Steph Warren is describing is we have
an idea where we want to go, and we know where we want to start,
so we start modestly. We put a segment in. We let it run for 90
days, and we see what hiccups and burps, and then we fix that because we can find it in that narrow slice. Then we realize we need
to add some more capability, and we do that.
Over time, it sounds like these incremental approaches would
take longer, but they are actually faster, and that has been our
experience.
Senator ISAKSON. The thing I want to be sure of in leading up
to what I am about to ask you, is I have had one experience with
a statewide installation of a computer system into 179 schools that
I had to fix a bad problem that was related to patches where they
had tried to custom-make the software to be site-specific rather
than system-specific and the patches were used to correct that.
I am taking it from what Mr. Warren has said that you are phasing in the installation of the software but that it is universal. You
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are not patching at each site. You are patching it for the universal
system. Is that right?
Mr. WARREN. Yes, sir, that is the case. It is a national deployment. So, when we roll out capability, every regional office gets
that capability and they are able to use it the next day once it
comes online.
Senator ISAKSON. And you are not correcting a problem. What
you are doing is phasing in an activity. Is that right?
Mr. WARREN. Sir, we are adding more capability every time we
bring new functions online for the benefits folks.
Senator ISAKSON. Well, you are doing it the right way because
I did it the wrong way in the State of Georgia and I paid a terrible
price for it. So, that is why I ask that questionbecause you cannot patch site-specific stuff; you have got to do it universally in the
system.
Mr. WARREN. Yes, sir.
Senator ISAKSON. Dr. Petzel, I want to correct something that
was in the record. It was reported that you inferred thatI do not
think you probably did infer because I have talked to you about
this before when you testified at our field hearing.
But you had a hearing in February with the House Veterans Affairs Committee, and you stated, * * *the IG report related to
mismanagement of the [Atlanta] VAMC did not connect deaths to
mismanagement.
But I believe you have stated before the hearing in Atlanta, as
well as personally to me on a number of occasions, that there were
mismanagement issues that contributed to the suicides in Atlanta.
Is that correct?
Dr. PETZEL. You are absolutely right, Senator Isakson. I had
misspoken in that I was referring to the review of the contract, not
the review of the care on the facility.
The contract review by the IGthey did not directly connect it,
but they did very definitely connect the activities on that ward
with a suicide death. You are absolutely right.
Senator ISAKSON. Well, because of what you have done on this,
I wanted the record to reflect accurately what you said in both
cases.
I want to publicly acknowledge the fact that you have come to
Atlanta and met personally with survivors of some of the suicide
victims in Atlanta where you provided a great service at a great
sacrifice on your part to do so. It is very much appreciated.
Secretary Shinseki, on this issue of suicides, one of the big questions that is being askedand there is a lot of press looking into
this in Atlanta, and I am sure something is going to be uncovered
one of these days, so I want to be prepared to answer this question.
Are there contractual limits or union limits, or what kind of limits do you have, to reprimand or correct or otherwise dismiss an
employee for inappropriate activity, mismanagement, or contributing to the failure of the system to deliver what it is supposed to
deliver?
Explain to me what you have to do to discipline or reprimand or
move or fire an employee.
Secretary SHINSEKI. Senator, I would say that I believe we have
the tools that we need. First of all, VA employees, by and large,
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30 percent of us are veterans ourselves. So, we have familiarity
with the issues veterans face, and there is a tie to them; and we
are deeply committed to our mission. In these discussions, transparency and accountability count as we are trying to establish and
maintain trust.
I would say that in 2012 we dismissedinvoluntarily removed
over 3,000 employees. In 2013, we did the same.
Senator ISAKSON. Is that total VA or just the medical services?
Secretary SHINSEKI. This is all of VA, but a very large part of
us is the Veterans Health Administration. They account for 70 or
80 percent of our workforce, and at 3,000, we are talking about a
percent of our workforce. Six senior executives were also dismissed
over the past 2 years.
I think what I would also like to add here is that many of these
incidents were discovered by VA employees, raised by them for our
attention. We then, as transparently as we could, did our investigation, shared the information so others could learn from it and then
set about correcting and then preventing future occurrences.
An important part of this is the courage and willingness of VA
employees to stand up and reportin some cases on themselves if
they made a mistakewhich allows us to take the corrective actions we have been able to do.
I, for one, value that. I never want to see us lose that. So, this
is part of the environment of trust that we are trying to retain.
It is unfortunate anytime a suicide happens. It is a terrible tragedy. Or, anytime we lose a patient under our care. The important
thing is to never let it happen again or, at least, commit to never
letting it happen again.
To do that, we have to find out what happened and get about
taking corrective action, then holding people responsible where
their performance did not meet our standard. As I said, I think we
have done that here in the past 2 years.
Senator ISAKSON. I appreciate that answer.
I have run over my time. I want to go to Senator Murray, but
before I do, very briefly, 3,000 per year the last 2 years have been
dismissed in terms of VA employment for various, different failures
to perform services.
Secretary SHINSEKI. That is correct.
Senator ISAKSON. How long does it take from the time you initiate an action to dismiss an employee for cause until you actually
dismiss them? How long does it take you to go through that
process?
Secretary SHINSEKI. A good question. I probably ought to do a little research and provide that to you for the record.
[Responses were not received within the Committees timeframe
for publication.]
Senator ISAKSON. Send me a memo. By the way, this is coming
from a reporter out of Atlanta, so, I am trying to give you a headsup, because I want to be able to have the right answer when they
call me, too.
Secretary SHINSEKI. OK. Well, let me provide you a good answer.
Senator ISAKSON. Senator Murray.
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STATEMENT OF HON. PATTY MURRAY,
U.S. SENATOR FROM WASHINGTON
Senator MURRAY. Thank you very much, Senator.

Secretary Shinseki, thank you for being here as well as all your
team.
Secretary Shinseki, several times you and I have discussed my
concerns about getting medical centers the researchers they need
to provide top quality care for our veterans.
The Spokane Medical Center recently prepared a draft response
to questions from the network about their budget. They talk about
the significant challenges of declining budgets, of numerous staffing vacancies, and leading the network in new veterans patients.
They also said, Overall, senior management is very aware of the
budget shortfall and is taking actions to limit the deficit. However,
most actions will significantly limit staffing levels and access to
care. These actions will have, and have had, a significant negative
impact on moral and will drive some dissatisfaction among patients.
Dr. Petzel, I asked you a similar question about a similar budget
problem at Indianapolis, at our hearing back on the 2012 budget,
and you told me there was no evidence that any medical center
would be unable to provide the care that we all expect. Unless your
view has changed, Spokanes assessment seems to disagree, and I
wanted to ask you what you and the network are going to do to
get Spokane the resources that they do need.
Secretary SHINSEKI. Let me turn to Dr. Petzel for details here.
Dr. PETZEL. Senator Murray, thank you.
I am assuming that that is some employees assessment of the
situation; it is not the senior leaderships assessment of the circumstances in
Senator MURRAY. It is the senior leaderships assessment.
Dr. PETZEL. I am not aware of this.
We do believeand the budget was distributed back in October,
and at that time, it was the consensus of the network directors and
the facility directors that they had sufficient funds to
Senator MURRAY. The questions were asked to them of the VISN,
and they responded back. So, it was the senior leadership at the
Spokane VA center, saying very clearly, they do not have the dollars to be able to do the duties that they need.
Dr. PETZEL. Senator Murray, I will have to go back and talk with
both the network and with Spokane. This is information that is
new to me.
Senator MURRAY. OK. Well, their draft response also calls for a
discussion about the mission of their medical center. It asks if they
are going to remain a full-service medical center and whether programs and services should be eliminated. This is deeply concerning
to me.
Are there plans to reduce services at the Spokane Medical
Center?
Dr. PETZEL. We have no plans to do so.
Senator MURRAY. OK. Well, I need you to follow up on that and
let me know what is happening, why they are facing such a budget
shortfall. It was very clear in the documents that we have seen
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that they are facing an extreme budget shortfall that is hampering
their ability to care for the veterans in that region.
Dr. PETZEL. We will follow up.
for publication.]
Senator MURRAY. OK. I also wanted to ask both of you about the
Walla Walla State Veterans Home. As you know, I am very concerned about that, especially because the budget request proposes
reducing funding for State veterans homes grants. These veterans
have been waiting a very long time for this facility. We have more
than 1,000 veterans who need care.
So, I want to ask whether this system that we currently have is
correctly prioritizing State home projects? Do we have enough flexibility, and how are we going to ensure that we have got the funds
for State veterans homes like Walla Walla?
Dr. PETZEL. Senator Murray, you and I have discussed on numerous occasions the Walla Walla State Veterans Home, and I
share your angst about that particular project.
We are looking at whether there is a solution that will allow us
to use the 2014 money in order to accomplish that construction, but
we are not finished looking at what the alternatives are. Obviously,
after we have done that and discussed it with the Secretary, we
will get back to you.
Senator MURRAY. OK. We need to know where that is going and
overall, meaning not just that one, but all of them. How are we
going to deal with these veterans homes with declining budgets?
I think that as members of Congress we need to know what the
need is, and then we need to figure out how to fund it rather than
just being told everything is OK.
So, I want to know specifically about Walla Wallawhat we are
going to do, and the funding of State veterans homes in general.
Finallyand I know we have another votethe War in Afghanistan is drawing to a close. We have more and more veterans coming home, who are going to seek care at the VA, and we are going
to see this continue, I think, in the years ahead.
I think we all have this thought that when the war is over we
do not have to worry about spending care on veterans anymore, but
the exact opposite is true. A lot of veterans are going to come to
the VA for the very first time in the coming years, and sometimes
the conditions that they have have dramatically worsened.
So, I am very, very concerned about the budget request reduction
for funding of TBI-specific health care and research. Why are you
proposing to reduce spending on TBI care when we know that as
these servicemembers come home and their conditions worsen they
are going to be seeking care at the VA for the first time?
Dr. PETZEL. That is an excellent question, Senator Murray.
If you look at the money spent in 2011, 2012 and 2013, there is
a slight decline in that, which is projected to continue. The specific
reason for that is that we have had an almost 70 percent decline
in the number of severely injured Traumatic Brain Injury patients
that are going into our polytrauma centers. The number of people
with mild-to-moderate TBI has continued to increase.
Senator MURRAY. That is right.
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Dr. PETZEL. The cost of taking care of those people is much,
much less than it is providing care for the patients that end up in
our polytrauma program.
So, while we are going to be taking care of more people, absolutely true, we are going to be doing it at less cost because we are
not going to be dealing with the people that are so severely injured
in the war.
And the second thing is that the mild-to-moderate TBI patients,
much of their care is absorbed into and seen in the mental health
budget; we are talking about PTSD, depression, and other mental
health conditions.
There is no relaxation of our concern about TBI. This is a
Senator MURRAY. All right. I just want to make sure we stay focused on that, and if we do see the costs are not being met, that
we are aware of that situation sooner, not later.
Dr. PETZEL. Yes.
Senator MURRAY. OK. Senator Isakson, I know another vote has
been called so you and I need to go to the floor.
I appreciate this time here today. Thank you and thank you to
our witnesses.
Senator ISAKSON. Bernie and I are about the same age. I think
he can make it, and I will keep the hearing going. If he runs out
of gas, then we will adjourn the hearing real quick.
I have another question if I can ask it while we are still going.
And we apologize for the gymnastics with the vote.
Mr. Secretary, in your implementation of several initiatives regarding the transformation process at VA, you have instituted
mandatory overtimes, segmented lanes, the Veterans Benefits
Management System, fully developed claims, e-benefits, et cetera.
Can you tell us which of those initiatives have proved successful
and beneficial to VA?
Secretary SHINSEKI. Certainly. I think I would just cap it all and
say all of those have been successful, some more so than others,
but in some cases their delivery came at an earlier point, and we
have had more time to assess them.
Let me turn to Secretary Hickey for some details here.
General HICKEY. Senator Isakson, I would couch it by saying the
following: We have implemented them, as the Secretary has said,
on sort of a staggered approach. I can tell you that many of them
contributed to our record-breaking 1.17 million claims production
at a high quality and accuracy level last year alone.
I will tell you we are 26 percent ahead of where we were even
last year at our record-breaking levels of production. In fact, by example, our hard-working VBA employees, who are 52 percent veterans themselves, are, as you said, working overtime 20 hours a
month to produce, in the month of February alone, double the production than we have made in any February before.
So, we are seeing all of these different efforts producing good
value for our veterans in terms of timeliness and accuracy.
I would call out one success in particular from our veterans service organizations, and that is our fully developed claims process,
where since February of last year we have gone from 3 percent of
our claims being fully developed to over 28 percent of our claims
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being fully developed, and that will do nothing but add to the benefit to a veteran as we move forward.
Senator ISAKSON. Thank you for the answer, and I will turn it
back over to Chairman Sanders.
Chairman SANDERS [presiding]. Thank you very much, Senator
Isakson.
I apologize for not knowing what just proceeded, but let me go
to an issue that I think is on the minds of many Americans and
people in the veterans community, which I know the VSOs are concerned about, and that is the overall issue, Secretary Petzel, about
mental health in general.
The country, above and beyond the VA, faces a crisis in lack of
quality, affordable access to mental health care. With several hundred thousand folks coming back from Iraq and Afghanistan, dealing with TBI or PTSD, it certainly is a problem within the VA.
Can you give us an overview of how we are doing in dealing with
these serious problems and then also deal with another issue that
is of concern of us; that is the issue of suicide?
Secretary SHINSEKI. Let me start and then I will ask Secretary
Petzel to provide some detail. I will start on mental health first.
I would say it is a discussion we have had with you, Mr. Chairman,
and other Members of the Committee here.
Frankly, we have been at war for over a decade, and we have
small professional formations, smaller than when I served, who
have carried this responsibility for carrying on these two operational missions now for this long. So, because of the size of the
force, they are rotated a number of times, multiple times, which
compound the issues, especially in mental health.
Over these 5 yearssix budgets nowwe have worked and increased the mental health budget by over 60 percent because of the
discussions we have had. We owe these youngsters the best we can
provide.
Budgeting is a little bit reactive. We look at whom showed up at
our medical facilities, and we then ask for resources to take care
of the next population if, in fact, there has been an increase.
We are working with DOD to try to anticipate what our requirements are going to be just at large and trying to understand what
the mental health piece of that is.
With that, let me ask Dr. Petzel to address some of the details
here.
Dr. PETZEL. I want to add, Senator, to what the Secretary has
said.
This is a very important consequence of what we have seen in
this warsmall force, repeated deployments, and a very recognizable number of people, perhaps 15 to 20 percent, returning from
that conflict with depression, PTSD, anxiety disorders, chemical dependency, sleep disordersthings that very much have a bearing
on their mental health. In 2015, we are expecting to treat about
1.7 million people with our specialty mental health services and
spend about $7.1 billion on mental health services.
Let me just go through a few of the things, Mr. Chairman, that
have been done over the last several years.
First of all, since March 2012, we have hired 2,400 additional
mental health clinical providers so that we now have onboard over
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20,000 clinical professionals delivering mental health services. It
has had an impact on a number of things.
The access measures have improved. They are not perfect yet,
and they are not where we want them to be
Chairman SANDERS. We heard this morning, if I can interrupt,
that there are still unacceptably long wait times in certain facilities
around the country.
Dr. PETZEL. That is absolutely true, sir. There are places where
we are having difficulty with wait times, primarily because we
have difficulty recruiting people into the positions that we need. Individual psychotherapy, as an example, is something that in some
parts of the country we have to wait long periods of time for.
However, established patients across the country95 percent of
them are being seen for an appointment with 14 days. The most
important group, patients that are new to the VA and new to mental health, 90 percent of those patients are being seen within 14
days. Of course, if someone walks into urgent care or walks into
the emergency room, they are seen immediately.
Chairman SANDERS. All right. I know, Senator Tester, you have
to leave soon. Why dont you take over?
Senator TESTER. Well, thank you, Mr. Chairman.
I want to echo and thank you all for being here today. I very
much appreciate your service in the past and currently.
General Shinseki, the backlog is always a big thing, and we will
be talking about the backlog until we get it down to a point where
we do not have to talk about it anymore. Can you give us an idea
on what the shutdown did to your backlog numbers?
Secretary SHINSEKI. Say that again please.
Senator TESTER. What did the government shutdown in October
2013 do to your backlog numbers?
Secretary SHINSEKI. Frankly, the impact was less than we were
concerned about, primarily because our employees went into high
gear and just worked overtime, anticipating that this thing would
grow. So, they were able to hold it stable for the month of October,
but since last year we have greatly reduced the backlog.
A great concern at the end of October was if the shutdown continued we would put at risk all the benefits checks that were already decided and veterans receive every month, that we were not
going be able to process, cut those checks and distribute thema
significant number of veterans and large monies.
Senator TESTER. Thank you.
I want to talk a little bit about the paper versus electronic medical record. You are running both right now, correctpaper and
electronic?
Secretary SHINSEKI. Yes, we are.
Senator TESTER. How has the DOD been as far as have they
made the transition to electronic medical records yet, or are they
still lagging back?
I know we had a meeting with the Chairman of Appropriations,
I think about a year ago right now, as a matter of fact, with both
of you and others.
Secretary SHINSEKI. DOD has its own electronic health record
just as we do.
Senator TESTER. Do they interface?
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Secretary SHINSEKI. They do not interface in the way that we
think is the future, but we have created a joint viewer developed
by our people that will reach into the DOD database, reach into
ours and pull up a single screen where a clinician, either in DOD
or VA, can care for patients, then those decisions reside in their respective databases.
Right now, DOD is developing, or acquiringthey are on an acquisition track to see what the next electronic health record could
be for them.
We are tracking them. We have our electronic health record, and
our plan is to, with the support of the Congress, release some dollars that are on hold
Senator TESTER. OK.
Secretary SHINSEKI [continuing]. To allow us to get up to level 4.
Senator TESTER. It would seem to me that part of the backlog
has to do with two different medical records. Is that fair to say?
Secretary SHINSEKI. It has been, and we have worked to try to
mitigate some of that.
Senator TESTER. OK. Well, let us know what we can do to help.
I know there are some on this Committee that serve on the Armed
Services Committee, too, and I think we can push because you
should beI mean, it should be, quite frankly, seamless. I think
that is the way it should be.
Secretary SHINSEKI. Senator, after good work between both our
staffs, in January, DOD began sending us service treatment
records electronically. So, we are beginning to get those records
electronically now.
Senator TESTER. OK, good.
Stating some statistics that you guys already know: there are 3.1
million veterans enrolled in the VA health system that live in rural
America; that is about 36 percent of those that are enrolled.
Out of the total request for telehealth of $567 millionI am talking about telehealth73 goes to rural telehealth. That is about 13
percent. It seems like it is about a third of what it should be.
Could one of you tell me why the amount is where it is?
Secretary SHINSEKI. Let me ask Dr. Petzel to provide some
detail.
Senator TESTER. Sure.
Secretary SHINSEKI. In addition to telehealth and the breakout
that you describe, we also have a rural health care account that
also provides money for rural areas.
Senator TESTER. OK.
Dr. PETZEL. Senator Tester, providing adequate and good health
care and accessible health care to rural veterans is a high priority
for us, as you know, because that is a large percentage of the people that live in this country, of our veterans.
The telehealth program primarily serves rural America.
Senator TESTER. OK.
Dr. PETZEL. I would have toI do not know where you got your
figure, so I have to go back and see it.
Senator TESTER. I got my glasses now. So, it came from my staff.
Dr. PETZEL. If we put all the equipment that is in our tertiary
care medical facilities as focused on providing consultation to more
rural areas, I would imagine
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Senator TESTER. OK.
Dr. PETZEL. I would like to, if you do not mind
Senator TESTER. We can flesh that.
Dr. PETZEL [continuing]. Go back and look at that.
for publication.]
Senator TESTER. Yes, I would appreciate that.
So, I was down in Salt Lake City and saw the telehealth booth
where the folks out there were delivering servicesI believe to
Bozeman, MT, when I saw it. It is very impressive, and I think it
has got tremendous upsides.
I say that as somebody who was opposed to telehealth for mental
health conditions, though you have turned me around on it although I do think you have to look eye-to-eye once in a while, too.
Chairman SANDERS. Thank you, Senator Tester.
Let me get back to the issueI am sorry. Senator, Johanns, I
apologize.
Senator JOHANNS. Thank you, Mr. Chairman.
Mr. Secretary, during the break here, we have had an opportunity to take a look at the funding on the four capital projects that
you have mentioned.
Secretary SHINSEKI. So, have I, Senator.
Senator JOHANNS. Yes, do you want to correct the record?
Secretary SHINSEKI. I was going to look forcorrect the record.
Senator JOHANNS. Yes. As I see it, the New York facility is requesting $150 million in the future.
Secretary SHINSEKI. I believe that is correct.
Senator JOHANNS. Long Beach, 161. San Diego, 21, thereabouts.
And, West Los Angeles, about 300. So, for a total of $631 million,
which is not that far north of what you are getting this year for
capital improvements.
So, I look out there another year, recognizing that those are
probably just estimatesit could be higher. It could be lower, I
guess, although my suspicion is they will be higher at the end of
the day.
We are probably not going to make any progress on the list next
year either. We seem to be stalling here.
Secretary SHINSEKI. Yes. I would not say that I am totally comfortable with where we are. I mean, this is something we have
worked hard for 5 years.
I would add to the numbers that you just described, Senator,
that we do have this Opportunity, Growth and Security Initiative.
It is in the investment fund, and we have another $400 million in
there. So, if we were able to leverage that, it would provide us
about a $1.9 billion construction capability this year.
This year, 2014, it is 1.7. So, there is a slight increase.
What I can tell you is that the facilities we have today will continue to be maintained to be safe and secure environments even as
we wait on these long-term projects. I will continue to work to try
to get more leverage into our major construction account. This
years major construction account is about a 60 percent increase
over the 2014 enterprise.
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I will seek your help and try to do better at getting some of these
projects addressed, but it is a long-term program.
Senator JOHANNS. Yes.
Senator Blumenthal.
STATEMENT OF HON. RICHARD BLUMENTHAL,
U.S. SENATOR FROM CONNECTICUT
Senator BLUMENTHAL. Thank you, Mr. Chairman.

Thank you, General, and thank you to your team for being here
today. Thank you for your service to our Nation over many years
and for providing information to me at our last meeting.
I think at that meeting your staff was going to provide some of
the information relating to Connecticut on backlogs, and if they
could do so, I would be very appreciativeConnecticut-specific information and then any additional information that you feel will inform us on the trends in those backlogs nationwide.
Secretary SHINSEKI. I regret we have not gotten those to you yet,
Senator. We will have it to you today.
Senator BLUMENTHAL. Thank you.
I want to ask about homelessness. You have made homelessness
a priority. Ending homelessness by 2015 is one of your preeminent
goals, and you have a number of strategies that have been proposed for ending veteran homelessness, including the use of VA/
HUD vouchers, which keeps veterans in their communities.
We have a facility in Rocky Hill, CT, that is essentially about
half unused. There are more than 450 available dormitory-style
beds. I am going to write you a letter about it because only about
250 or so of those beds are used at the moment. It is a facility that
includes dormitory-style living as well as individual housing.
But I am very troubled by the lack of usage, which may well reflect the need to provide psychiatric care for residents or help counseling and medical care for people suffering from addiction. But
whatever the cause, I am hopeful that the Federal VA, your agency, will help our State Department of Veterans Affairs in providing
the services that are necessary to make sure that this facility is
fully utilized. There are beds unused because of issues that really
should be addressed.
The partnership between our State and Federal VA facilities, I
think, is tremendously important.
I am not asking you the question now to seek your detailed responses to what the VA would do, but simply, number 1, to ask for
your commitment that you will work with me and our State VA in
seeking solutions; and, number 2, that you will inform the Committee more generally as to whether these kinds of issues are national in scope.
Just in case I have not made clear what I view the issue as
being, it is essentially that there are perhaps physical facilities
available to provide homes to veterans who are suffering on our
streets, in our alleys, under bridges, but cannot be used because of
the need for services addressing addiction, psychiatric care, other
kinds of issues that obviously are complex and challenging, as you
and I have discussed on occasion.
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I know of your commitment to addressing those issues.
So, really, it is a commitment to work with me and our VA officials and address the problem more broadly, if you see it as a national problem.
Secretary SHINSEKI. Sure. Senator, I will make that commitment
to work with you.
I do not know the specifics here, but I would say in the past 2
years we have created a fund called the Supportive Services to Veteran Families, which is a fund that allows us to provide grants to
a variety of non-profit, local as well as national, agencies who work
with us in housing the homeless.
For the last 2 years, we have distributed about $300 million each
year, and I believe we are looking at, if this budget is approved,
increasing that to $500 million. I know we haveit is a competitive
process, and there is not enough to satisfy all the bids that are in,
but it is handled in a way that every State gets attention.
We are more than happy to work with you on this.
Senator BLUMENTHAL. I very much appreciate that.
I know you are also aware and attuned to the medical records
interoperability issue. Senator Tester has asked you about it.
I just want to say to you on the record here, as I have said privately in our meetings, if there is anything that I can do as a member of the Armed Services Committee to speed or expedite the Department of Defenses more positive approach on this issue, I would
be more than happy to do so. I think our Committee is very interested in this issue, as you know.
Secretary SHINSEKI. Thank you. Thank you, Senator.
I would assure you that Secretary Hagel and I discussed this. We
meet routinely, and this is a topic of discussion between us. And
so, at our level, this has the priority you would expect.
My time is expired. I thank you, Mr. Chairman.
Chairman SANDERS. Let me get back to health caretwo issues.
I am a great believer in primary health care. I think one of the
reasons as a nation we end up having the most expensive health
care system in the world is we do not do enough primary care and
we do too much specialty care.
The VA has historically, or at least in recent years, done a good
job. What do we have?over 800 CBOCs around the country.
We also have a whole lot of federally qualified community health
centers, and I have worked very hard to expand those programs,
and I believe in them.
I know that we have a partnership now that has been piloted,
I guess, with both the Indian Health Service and, I think, federally
qualified health centers. In other words, where you have a veteran
who may be a distance away from a medical center or a distance
away from a CBOC, that person can now access an Indian Health
Service clinic or an FQHC in some pilots.
Can you talk about what is going on and what you would like
to see, plus what is the potential there?
Secretary SHINSEKI. Dr. Petzel.
Dr. PETZEL. Thank you, Mr. Secretary.
Chairman Sanders, we have two different programs. We have a
program with the Indian Health service, which has been very valu-
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able in serving an incredibly needy group of veterans, and that is
that we pay the Indian Health Service to provide services for veterans in their
Chairman SANDERS. So, a non-Indian can walk into an Indian
Health Clinic?
Dr. PETZEL. No, this is VA paying for veterans to be cared for
in Indian Health Service
Chairman SANDERS. Right.
Dr. PETZEL [continuing]. Or tribal clinics, not non-Indians, but
Native Americans. So, we pay the bill, and they get treated in their
own clinic.
Chairman SANDERS. Oh, I see. OK, if a CBOC is not nearby.
Dr. PETZEL. Right.
Chairman SANDERS. And this is limited to Native Americans.
Dr. PETZEL. That is correct. This is not a program that is involved in the federally qualified health care program.
Dr. PETZEL. We are piloting contracts with 24 of those around
the country to see how it works in terms of the exchanges of
money, et cetera. And I fully expect that we will expand that program as it proves successful.
Chairman SANDERS. All right, so let me understand. A Native
American can now go into the Indian Health Service, and their
service is paid for by the VA.
Dr. PETZEL. If they are a veteran.
Dr. PETZEL. An eligible veteran, correct.
Chairman SANDERS. Right. OK. And you have now a pilot with
a number of FQHCs around the country.
Dr. PETZEL. Right, to care for veterans in those communities.
Chairman SANDERS. So, this is where an FQHC is near a veteran
and a CBOC is not; is that the
Dr. PETZEL. That is correct although in this case they have to be
enrolled with us.
Dr. PETZEL. And we make the referral to the Federal clinic, but
that is, in essence, yes.
Chairman SANDERS. And do you see the opportunity to expand
that partnership?
Dr. PETZEL. We are going to be evaluating that pilot project. If
it looks like it is a success, we will find other places where we can
expand this, correct.
Chairman SANDERS. So, the bottom line therea veteran lives
near a community health center, not near a CBOC; the VA would
pay for the care at a community health center.
Dr. PETZEL. If they were enrolled with us
Dr. PETZEL [continuing]. And if we made the referral, correct.
Chairman SANDERS. OK. Let me ask you another question, General Shinseki or Dr. Petzel.
We all understand the mental health needs that have arisen out
of the wars, and we have heard from you that you have greatly expanded the number of mental health counselors and therapists and
so forth.
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Say a word aboutat the end of the day, I mean, obviously, we
need that. We need to make sure that people have access to mental
health services in a timely manner.
But, how effective are the therapies now being offered in terms
of dealing with the very difficult issues of Traumatic Brain Injury
and Post Traumatic Stress Disorder? Are we making progress?
Secretary SHINSEKI. Dr. Petzel.
Dr. PETZEL. Thank you, Mr. Chairman.
We are making progress. Traumatic Brain Injury actually has
been quite dramatic. The Secretary has frequently talked about the
Emerging Consciousness Program, where people have been unconscious for periods of three to 4 months and now have emerged from
consciousness and, if you were to casually talk with them, you
would not know that they had ever had a significant brain injury.
So, with the severely injured individuals, we are making
progress.
We are also making progress in treating PTSD. The evidencebased therapies that the VA has developed have been shown in the
literature to be successful in ameliorating the symptoms of PTSD.
You have mentioned something that is very important to us, and
we are dealing with this group of veterans who need our services
so badly coming back from the war, and that is:
How do we measure how well we are doing?
How can we tell that the $7.1 billion that we are requesting
to provide care is actually improving the health of these people?
We have embarked now in mental health on a series of outcome
measures, which we will be looking at over this year and be able
to talk about at this time next year, that measure the influence of
care on the symptoms of PTSD, that measure the influence of care
on the Beck Depression Scale administered over time.
We are going to be looking at outcomes in anxiety disorders and
depression.
We are going to be looking more carefully at people who are at
risk for suicide and if we have actually improved their chances of
not having another suicide attempt.
Chairman SANDERS. But, in general, you are telling us that you
think the therapy
Dr. PETZEL. We believe that we are having an impact on the
mental health of the people that we are treating, correct.
Chairman SANDERS. OK.
Secretary SHINSEKI. Mr. Chairman, let me just add to this.
Chairman SANDERS. Sure.
Secretary SHINSEKI. This is a tough area for us, and we continue
to apply. I think you will see that we are putting $7 billion against
mental health. We have a separate funding line for Traumatic
Brain Injuries, and then we do research in this area.
If you think of TBI, I would invite you to think about our polytrauma centers, the five polytrauma centers that ring the countryTampa; Richmond; Milwaukee; Palo Alto, CA; San Antonio,
TX. These are the five tier1 polytrauma TBI centers of excellence
which began many years ago.
Chairman SANDERS. In general, Mr. Secretary, these are for the
more severe cases; is that correct?
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Secretary SHINSEKI. More severe cases.
Once they are stabilized, then there is a tier 2, which I think
there are about 82 tier2 polytrauma locations.
And then there is even a tier 3.
The whole point of this system is as people improve they are
moved closer to home, where, ultimately, they will be sustained.
All of us had a chance to sit in the State of the Union address
recently. In closing, the President introduced Sergeant Cory
Remsburg. Sergeant Remsburg is a graduate of one of our Emerging Consciousness programsa 70 percent success rate in bringing
patients back from deep comas, comatose. Years before, people
would have given up and said there is no hope.
Chairman SANDERS. So, these are people who were injured in an
explosion, became unconscious, and remained unconscious for
months.
Secretary SHINSEKI. For months.
Chairman SANDERS. Now you are saying we are having a 70 percent rate in bringing people back to normal?
Secretary SHINSEKI. Bringing back to consciousness. And their
return isover time, we have some tremendously wonderful successes, where if you and I were having a discussion with one of our
graduates we would have a hard time understanding that; but,
then there are others who are not as far along. And there are various stages.
Chairman SANDERS. So, you see the VA making some significant
breakthroughs in this?
Secretary SHINSEKI. This is a great contribution here. It is part
of the TBI research, although it is being done in one of our polytrauma centers. It is research that is giving us opportunities to see
a win.
Chairman SANDERS. My time expired a long time ago.
Senator Boozman.
STATEMENT OF HON. JOHN BOOZMAN,
U.S. SENATOR FROM ARKANSAS
Senator BOOZMAN. Thank you. It is good to see you, Secretary

Shinseki. We appreciate all of you alls hard work for our veterans.
In following up with that, last Congress, we passed a law that
would guarantee veterans with TBI that they would receive treatment aimed at maximizing quality-of-life rather than restoring
function, though I do not think we have really seen the implementation language of that. Can you expound on that?
And it is great to hear the stories that you are telling.
One of our concerns with these things is that we do not want to
have some arbitrary cutoff date when science tells us that you have
gone as far as you can go, and yet, we are learning things. And
then, too, we want to restore quality-of-life issues rather than just
function.
Secretary SHINSEKI. Yes. I am going to call on Dr. Petzel for the
specifics here.
Senator BOOZMAN. Sure.
Secretary SHINSEKI. But I would say that the program I just described, the Emerging Consciousness, is proof of your point, that
we know more today than we did 5 years and there should not be
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an arbitrary line drawn that says we cannot help this individual
anymore.
In fact, it is the folks down in Tampa who have tried anything
and everything to try to get a response, and 70 percent of the time
they succeed, which is great for the rest of the country. It can benefit from the learning that has been created through this research
effort on TBI, which this Committee has funded.
Senator BOOZMAN. And we are notyou know, we are talking
about a finite number of individuals. I mean, this is not a tremendous amount of people. It is certainly a very significant amount.
You may know that I am an optometrist by training. A year or
so ago some of the residents were in that worked at the medical
center and also were helping, rotating through the veterans hospital there. But, just individuals that had things that you really
could not actually quantify as to what was going on, but you knew
from their histories that they were different now and having trouble with cognitive this and that.
Can you elaborate, Dr. Petzel, on what we are doing to make
sure, again, that we are dealing with quality-of-life issues versus
some arbitrary function number?
Dr. PETZEL. Thank you, Senator Boozman.
I want to echo the comments that the Secretary made and also
add that I think one of the pieces of evidence about your concern
about restoring people to the quality-of-life that they would have
wanted, or as near to what they wanted had they not been injured,
is over 75 percent of the people that go through our polytrauma
centers actually return home, sometimes with great effort and tremendous amounts of support, but they are back in their homes,
with their families, getting the support services that they need in
order to be able to participate in their community.
The people that I think you are referring to are those that are
less severely injured, have injuries but are not confined to a bed,
are not people that have spent a year and a half in a polytrauma
center, and there is a tremendous
Senator BOOZMAN. Well, really both, in the sense it is one thing
to go home, with restored function as best we can do; it is another
thing to go home and be somewhat integrated into society but not
fully integrated or integrated to theso really, a little bit of both.
Dr. PETZEL. And that is our aim with every single one of these
patients, to provide them the capacity to do the maximum that
they can and want to do in terms of integrating their life back into
society.
The example is it is not quite polytrauma, but it used to be that
you were happy to getsomebody was happy to get an artificial leg
if they lost their leg. That is not true anymore.
If you live in Minnesota, that soldier wants to go out and play
hockey. He wants to be able to function on the ice there. He wants
to be able to play baseball.
That is the kind of approach that we are taking with all of these
injured soldiers, sailors, airmen, and Marines that are coming to us
and really want to get back into society to do the things that they
had always done.
Senator BOOZMAN. Very good.
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We have advanced funding in the health care aspect. Has that
been a positive or a negative, or has it been something that has
given you the ability to plan a little bit better? How has that gone
along?
Secretary SHINSEKI. Senator, we first received that advance appropriation capability in 2012. So, here we are several years later.
We have had a little learning to go through. We are better at it
today.
Having a 1-year budget and planning and programming for a 1year cycle versus twothere is an adjustment you have to make.
So, we are pretty much through that, still learning from it.
For our health care accountmedical care, medical services,
medical facilitiesthat has been a great fit for what we do in
health care administration. On October 1, without having to wait
to see how the budget turns out, because of advance appropriations, they can write a contract for services for the entire year. Patients and employees are very well served, but primarily, our veteran patients are very well served by that.
Senator BOOZMAN. There are some of us that would like to give
you that authority, you know, extend that authority to other accounts. From your experience that you have had with the health
care aspect, would that be a positive or a negative?
The trouble that we have, as you all know better than anywe
were celebrating not too long ago, only a few weeks ago, that we
finally passed an appropriations bills and that was 3 months into
the year.
So, it is not like you generally go year to year. It is more like
you do not know what is going on for several months, and then finally you get some certainty.
Can you comment on if you feel like that perhaps would be a
positive thing?
I mean, common sense to me dictates that it would.
Secretary SHINSEKI. Senator, I would say anytime those of us
who are trying to help our workforce provide services, anytime we
can provide them predictability about what those services are going
to be for the entire year it is helpful for them. So, in the health
care account this makes pretty good sense. It would make sense in
other accounts as well.
But, I raise this issue as I did in testimony last October when
there was this discussion. In the case of the Veterans Benefits Administration, we cannot process a claim within our own confines.
To process a claim, we have to go to Social Security to validate
other disabilities. We have to go to IRS to validate, by the law,
threshold income requirements. We deal with DOD. We deal with
Department of Education, the post-9/11 GI Bill. We deal with the
Department of Labor on employability issues.
So, for me to say that we can do this without the investment
from other Departments, I think I would not be giving you the full
picture.
As I said in Octoberand I do not mean to lecture anyone here
the best way for us to see meeting our full mission would be to
have a budget for the Federal Government every year. That is
what would make all of our work much easier.
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Senator BOOZMAN. Thank you, Mr. Chair. I apologize for going
over.
Chairman SANDERS. Senator Blumenthal.
Senator BLUMENTHAL. Thank you, Mr. Chairman, and thank you
for having a second round of questions.
Thank you, Mr. Secretary, for being so forthright and helpful in
your answers to my questions.
Let me just begin again on a seemingly local issue. Our VA facility in West Haven has been found to be deficient in a number of
serious respects by the inspector general of the VA. So, I would like
your commitment that you will work with me in seeking remedies
for those failings. They have been documented. The VA officials
have been very forthcoming and responsive to my visits and inquiries.
I would like to have the resources of the VA committed to providing the highest quality care in that West Haven facility.
Secretary SHINSEKI. You and I have the same goal, Senator.
Secretary SHINSEKI. I commit to working with you.
Senator BLUMENTHAL. Next item, going to PTS, you may be
aware of legal action that has been brought by the Yale Veterans
Clinic. The good news is you are not a defendant.
It was brought against the Secretary of the Army and a number
of other officials. For me, it is a very serious legal action but also
one that really embodies a moral imperative. It relates to veterans
of the Vietnam War, who have suffered from PTS.
The named plaintiff, Conley Monk, has suffered from PTS for 40
years. He was wounded in combat, and then he was wounded a second time because he was denied VA medical treatment for Post
Traumatic Stress. That condition was unrecognized at the time. It
was undiagnosed and, therefore, not treated at all.
As you and I have discussed, both in public and private, I know
you have a deep understanding and concern on this issue and that
changing his discharge from less than honorable to honorable is not
within your power. It is the authority of the review board in the
Department of Defense.
You have mentioned that you have regular conversations and
meetings with Secretary Hagel. I have asked about this subject in
the course in the Armed Services hearings. I believe that you are
sympathetic and supportive, as his he.
And, again, I would just like your commitment that you will
raise it privately and publicly with him because the urgency of this
cause, I think, is no less, perhaps even more than it was when we
last discussed it, and yet, there has been no general action to address this concern among the Vietnam veteran population generally, who may have suffered from PTS at the same rate as the
Iraq and Afghanistan veterans have done.
Secretary SHINSEKI. Certainly, Senator, I will commit to continuing to work this with you and work this as a priority as well.
We approached DOD and had those discussions that I have described and looking for a review of the character of discharge.
For one thing, as you point out, we did not do well by the Vietnam generation, and I happen to know many of them. So, part of
our commitment here is nevernot to repeat what happened there.
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So, if you go back 3 years, you will see a decision within the VA
that if a combat veteran has medically verifiable PTSD, we will
make the service connection and allow that individual to submit a
claim for benefits as well as treatment and move beyond this discussion of putting the burden of proof on the veteran to demonstrate how and why PTSD was an issue.
We have increased awareness about PTSD. We have increased
our funding in this area. I do think we are doing better but still
not enough with the current generation.
Many of our mental health issues, PTSD issues, still go back to
the Vietnam generation. We owe them better, and we are doing our
best to make up for lost time here.
We owe this generation, as well, the best care we can provide.
Senator BLUMENTHAL. I really appreciate your support on this
issue. I know you have a deep understanding and concern, as I
mentioned earlier.
By the way, I refer to it as PTS rather than PTSD because I
think that calling it a disorder gives it a kind of stigma that is
completely unjustified. It is Post Traumatic Stress.
I welcome your making this policy flexible so as to provide the
medical benefits, but of course, those benefits cannot be supplemented by other benefits, whether relating to employment and
homelessness and so forth that the VA has to offer, because of the
less-than-honorable discharge, not to mention the stigma of that
kind of discharge that they have suffered for 40 years or more.
So, I agree with you that it is a moral imperative, an obligation
of this country, not to mention the need to settle this lawsuit,
which I fully support because I think legally it is well-justified.
Secretary SHINSEKI. I would just offer to you, Senator, that the
character discharge clearly still remains a DOD issue; and I can
tell you that this is at the top of discussion. I know Secretary
Hagel is looking at it.
In the meantime, we have asked DOD to provide us a list by
name of veterans who, in some cases, may have been discharged
under rules that no longer existdont ask, dont tell, for example, behavior issues that could be PTSD.
We have about 73,000 names, and we are running those names
against our registry of homeless veterans, and thus far, we have
found about a 6,500 name match.
So, we are pulling those individuals into our review to see whether or not we can provide benefits and care, and we are. In those
6,500 cases, we are.
I think here shortly we have either written 73,000 letters to folks
on that list or will complete doing that shortly.
For those that we do not get a response from by this summer,
we will turn around and try to follow up on that, again, trying to
close this loop on folks who have been denied benefits and services
that they earned.
Senator BLUMENTHAL. Let me make one last comment which is
to thank you for, again, expanding the circle. I think it has been
a mark of your leadership that you have sought to increase the circle of accessibility and eligibility, whether it is Agent Orange or
other disability claims. Rather than kind of circling the wagons
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more closely, you have had the courage to try to increase availability and access.
I really do appreciate the point that you just made and, finally,
would say I am very concerned about discrimination against veterans, particularly in employment situations and most especially
when it comes to PTS.
My concern is embodied in legislation that I have offered that
prohibits discrimination. Whether it will pass, I certainly cannot
say. The odds are against any single piece of legislation.
But the evidence I am seeing, again, indicates that among a
small proportionand I emphasize it is maybe a small minority,
but it is thereof employers, there is this discrimination for whatever reason against veterans.
A law is a blunt and cumbersome instrument to work against it,
but I hope that perhaps I can work with you in documenting the
discrimination if it exists, then doing something to counter it.
Chairman SANDERS. Let meI am going to have to interrupt and
go to Senator Moran now.
Senator Moran.
Senator BLUMENTHAL. I apologize. I thought I was the last. So,
I apologize, Mr. Chairman.
Senator MORAN. Now my feelings are hurt. I just thought you
were windy. I did not realize you were
[Laughter.]
Senator BLUMENTHAL. Well, that, too, but
STATEMENT OF HON. JERRY MORAN,
U.S. SENATOR FROM KANSAS
Senator MORAN. Mr. Chairman, thank you very much.

Mr. Secretary and your colleagues, thank you for being here.
I have three or four questions I would like to raise about specific
programs particularly of interest to me as a Senator from Kansas.
The first one is a programa law that was passed in 2010. I was
in the House of Representatives then and chaired the Health Care
Subcommittee on Veterans, and we were successful in passing a
bill called Access Received Closer to Home, ARCH. The crux of that
effort was to recognize, in particularly a State like ours, like mine,
that VA hospitals are a long way from many veterans.
We initially addressed that with outpatient clinics, and that provided routine services closer to home, but still miles and hours
away from many of the veterans in our State.
With the support of many of my colleagues, including the Senator from Arkansas, we were successful in passing legislation that
would require the VA to provide services, in a sense, in hometowns,
where the veteran chose to have those services provided if they
lived more than a certain number of miles from a CBOC or VA
hospital.
That was narrowed down before the bill was passed and became
a pilot program. That pilot program has been in place now for 3
years. Reports, I assume, are either on your desk or soon to be on
your desk.
My initial question is, do you have thoughts about this programs
success and what is the Departments plan for its continuance?
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Secretary SHINSEKI. The report has not yet arrived. So, I await
that.
I think we learned a lot from Project ARCH, and we have in the
meantime put in place some other initiatives that are VA programs
that address some of those lessons that we got out of ARCH.
I do not know what the next step is going to be with ARCH, but
let me call on Dr. Petzel to talk about some of the things that we
have implemented, not the least of which is telehealth to help try
to bridge even those remote and rural areas where veterans have
no access to health.
Dr. PETZEL. Senator Moran, thank you.
The pilot was done in five different networks, and as you know,
Kansas was one of them. Pratt County was actually the place
where we did that.
Various things were done. In a couple of instances, primary care
was provided, but in the bulk of places it was a specialty care kind
of phenomenon where if the veteran needed and wanted specialty
care in the community we were able to provide that.
We made progress in other areas since then, as the Secretary alluded to. With telehealth, telehome health, we are in a much better
position now to provide specialty care in remote areas that we
might have been three or 4 years ago.
In addition to that, in anticipation of the pilot for ARCH ending,
we have developed a new program nationwide called PC3, which is
a program by which we have developed networks around the country to provide specialty care on referrals. In other words, a referral
network, where if somebody lives in a remote area and a decision
is made they need to have specialty care and it is inconvenient and
not appropriate for them to travel, we can go to that contract provider under the PC3 contract and provide that care in the
community.
The program started in January when the first network was set
up. It is now fully operational around the country, and the business
is booming, so to speak. We are seeing the contract and the network being used all over the country.
In addition to that, we do have the capacitywe always have
hadto provide for fee-basis care in the community and have used
that extensively, particularly in places like Kansas, again, where it
is just not appropriate for someone to travel 200 miles to Topeka
or to Wichita or into Kansas City.
Senator MORAN. I appreciate that answer.
We want to continue to work with the VA to expand this program. Pratt County is one of them. It is important that we test
this, I suppose, in a small county although when the legislation
passed I expected it to be tested VISN-wide and the VA narrowed
it to a county, which is a significant difference in the outcome.
Let me highlight something that you said, which causes me to
bring up two other questions. You talked about telemedicine, for
example.
One of the problems that we have discovered in CBOCs is the
lack of physicians, of mid-levels. The Liberal CBOC on the Kansas/
Oklahoma border has not had a physician for more than 2 years.
You have been recruiting for more than 2 years with no success.
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The Topeka VA recently closed its emergency room services,
claiming they have a lack of physicians to man or person an emergency room. Now the VA in Topeka is telling veterans who show
up at their hospital that we have no emergency services; you need
to go to a commercial hospital.
The Secretary and I have had this conversation at, I think, every
occurrence in which he has appeared before this Committee or the
Appropriations Committee in this admonition, this request.
I understand the difficulty. I am a rural person. I know how difficult it is outside the VA to recruit physicians. But the VA has yet,
in my view, to find the solution to the lack of physicians and other
mid-level professionals within the system.
So, this problemif we delay going to the private sector, if we
delay going to the community hospital and the local physician, we
are exacerbating the problem where the CBOCs have no ability to
provide the necessary level of care and treatment. And even at a
hospital the size of Topekathe VA hospitalwe are told there are
not enough doctors to staff an emergency room.
One of the other aspectsand I do not want to be accused of Mr.
Blumenthals problem, of speaking beyond my time, so I am moving
quickly to my other questions.
Chiropractors. Again, a piece of legislation authored in the House
of Representatives in my day requires the VA to place chiropractic
care to meet the needs of veterans in every VISN. It seems to me
that the VA has been very slow to implement that legislation. We
have chiropractic are available, but there is no systemwide effort
at providing chiropractic care.
One, it can be a value. But, again, in a State like mine in the
absence of other health care professionals, chiropractic care becomes critical.
And before my 2 minutes past time goes any further, the final
thing I would raise with you is we are confused by something that
has happened in Wichita. The Dole VA Hospital and the McConnell
Air Force Base has been working.
And, again, the Secretary and I had the conversation I think the
last time you were in front of this Committee, about how do we get
the project that will combine those two facilitiesa hospital that
is already at McConnell and a VA hospital, the Dole Hospital. The
plan by the VA has been to combine those two and build a new facility on McConnell Air Force Base property.
Last yearand I need to look at my notesit was included in
the list, and I asked you, how do we move that up?
Well, Mr. Secretary, not only has it not moved up, but it is no
longer on the list. And, at least to our knowledge, no one at the
Dole VA Center can explain why last year it was being considered.
It was ranked.
My question to you is, how do we get a higher ranking?
And now it is gone entirely.
Secretary SHINSEKI. Senator, I owe you a better answer than I
am going to give you, which is that every year we re-look at priorities, and where we have a safety or security project that leaps up
that we have to do something about in the ordering that will move
a project forward.
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I will go back and research what the issue is with the Dole/
McConnell project.
My guess is it is still on our list of things to do. You do not see
it in the budget because the available funding covered those
projects that we could fund this year$1.5 billion in the base account and then $400 million in the investment account.
Senator MORAN. Thank you, Mr. Secretary.
The project was ranked No. 197 in fiscal year 2014; not on the
list this time.
Mr. Chairman, thank you.
Chairman SANDERS. If it is OK with the members
Senator BLUMENTHAL. Mr. Chairman, could I just give General
Shinseki an opportunity to respond to the question I asked.
I did not know whether you had a response on the issue of discrimination. You may have been interrupted without having a
response.
Before my friend from Kansas leaves, I want to say that I apologize to him. Senator Moran, my apologies to you for keeping you
longer.
Senator MORAN. Well, you set the precedent, and I followed
your
Senator BLUMENTHAL. You took advantage of it.
Sorry, General, please.
Secretary SHINSEKI. I would just say our approach has been
and it did not begin with my arrivalthat VA is a welcoming
place, and we have generously taken care of veterans for many
generations now. I think if you look at the decisions that have been
made in at least the last 5 years, our effort has been to provide veterans the care and benefits that they have earned without drawing
any walls around that statement.
Senator BLUMENTHAL. And I am not talking about VA benefits
right now. I am talking about private employers who may discriminate against veterans for whatever reason.
Secretary SHINSEKI. This is what I put into the area of what I
call the undiscussables, and it is a topic I discuss every opportunity I have with potential employers.
I assure them that at VA our experience is when we diagnose
and treat whatever the issue is, but even PTS or PTSD, that people
improve and that they should not let that be a barrier to them
making a hiring decision. They will not regret it. Our veterans are
very capable youngsters. They come with tremendous experience,
along with the kind of work ethic and discipline we all like seeing.
They will not regret making that hiring decision.
I am happy to work with you on how do we make that a more
compelling argument.
Senator BLUMENTHAL. Thank you very much.
Chairman SANDERS. If it is OK, let me just ask one last question,
picking up on a question that Senator Moran raised.
I wear another hat. I am chairman of the Subcommittee on Primary Care. We know that as a Nation we have a real crisis in
terms of whole areas, including in Kansas. I think it is a serious
problem in areas of Kansas, above and beyond the VA, where peo-
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ple cannot access a primary care physician. We have some of that
in parts of Vermont as well.
We tripled a couple of years ago, in the Affordable Care Act,
funding for the National Health Service Corps. The Presidents
budget was very generous again for the National Health Service
Corps, which provides debt forgiveness for those medical school
graduates or dentists who are practicing in underserved areas.
What kinds of programs does the VA have in terms of debt forgiveness or scholarships, or whatever it may be, to attract primary
care physicians into the VA to handle the problems that Senator
Moran raised?
Dr. PETZEL. Mr. Chairman, the VA has got a number of possibilities of attracting people into these remote areas. Let me just go
through them quickly. Then I will talk specifically about debt forgiveness.
We have retention bonuses. We have recruitment bonuses. We
have home buyouts, where we can buy peoples homes, allowing
them to make the move. We have got quite a bit of flexibility in
terms of salary. Our salary rates are competitive, and they are
flexible.
In terms of loan forgiveness, right now, I think the Secretarys
limit on forgiving educational loans is $60,000. That could be higher; I will just be blunt.
There are not many instances where you need to do that, and the
cost of it is not particularly extensive, but it can be a great incentive for somebody that is carrying $200,000 worth of educational
debt, coming out of college and medical school, to be able to have
a goodly portion of that actually forgiven.
Chairman SANDERS. If my memory is correct, what the Department of Defense does is say we will send you to medical school and
then get X number of years of your life after you graduate.
Dr. PETZEL. They do. And we have a program that is not unlike
that.
The difficulty is that you cannot predict where they are going to
go. It would be wonderful if you could take somebody that is a senior in college
Chairman SANDERS. Well, cant you write that into the contract?
We will pay for your medical school. We will send you
Dr. PETZEL. You do not get anybody to sign that contract.
With DOD, it is you are going to serve in the military, but you
have got a lot of flexibility in terms of what you do in the military.
With us, if we wanted to direct these people into things like rural
health, to go to Helena, MT, or Liberal, KS, you would have to
write that into the contract, and we have not been able to accomplish that right now.
Chairman SANDERS. I think it is an important issue that is worth
further discussion.
Dr. PETZEL. Could I mention just one more thing for rural? And
that is the use of advanced practice nurses, who are very versatile
and very flexible and actually have helped keep Liberal and its 278
patients goingthat and we have a provider that visits that area.
That is the only place in Kansas we are having trouble, interestingly. The rest of our clinicsI just checkedhave got the full complement of providers.
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We will continue to work on it, Senator.
Chairman SANDERS. Because people are shocked about Liberal,
KS. They cannot get that through their heads. [Laughter.]
Senator Boozman, did you want
Senator BOOZMAN. I would justI did not realize that you were
also involved in another committee.
This really is a huge problem, and it is not just with VA. It is
regardless of where anybody is at on the health care bill we are
going to have more people into the system. OK?
So, many of the providers are our age, and it is just something
that we really need to look at.
We can work hard and work hard on our making sure that the
veterans have the benefits that were promised, but if you have this
great deal and you cannot find anybody to provide the care it really
is a big thing.
Maybe that is something that at some point we could actually
have a hearing on.
Chairman SANDERS. I think that is a good idea.
Senator BOOZMAN. Get them to get the data overwhere we are
at now, where they feel like we are going to be five
Chairman SANDERS. And the point is, this is not just a VA problem.
Senator BOOZMAN. Exactly.
Chairman SANDERS. It is a national problem
Senator BOOZMAN. The trouble is, though, you cannotthis is
something that if we are going to be short on physicians 5 years
from now you cannot decide 3 years from now that you are going
to do something.
Chairman SANDERS. Absolutely right.
All right, can weSenator Moran, are you all right?
[No response.]
Chairman SANDERS. OK, let me
Senator MORAN. If I have a chance to follow up, I would be glad
to.
Chairman SANDERS. A brief, brief follow-up.
Senator MORAN. First of all, I would ask Secretary Shinseki if he
would give us an idea of when he is going to receive the report
about ARCH and when we then could see the results.
And for Secretary Petzel, I would just say that your response to
the Chairmans question about all the array of things we have to
offer physiciansit may be a long list, but it does not seem
sufficient.
I have asked this question at every hearing. What is it that we
can do? What are you missing?
I have never had an answer that says that we have now examined this; a solution to our problem that does not go away would
be additional pay, additional loan forgiveness, all the things that
are on that list but maybe more.
So, for the answer to the Chairmans question to be this is all
the things we have, I appreciate knowing that, but I just would remind you that it still does not seem to solve the problem.
Chairman SANDERS. Let me suggest this. I think Senator
Boozman raised the issue. Lets do a hearing on this. Does that
sound good?
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Senator MORAN. Sounds good.
Chairman SANDERS. OK. And we will get you guys back to do
some thinking about that.
Senator MORAN. And the answer to when we could receive a
report?
Secretary SHINSEKI. It is coming to me from Dr. Petzel. I just
asked him that question, Senator, and he said, shortly. So, I assume I will have it before the sun sets today.
Senator MORAN. All right. [Laughter.]
Thank you for holding his feet to the fire.
Secretary SHINSEKI. That is the way we define shortly.
Chairman SANDERS. With that, I want to thank all of the panel
for spending over 2 hours with us, for your thoughtful answers;
and in these very difficult times, we are proud of the work that you
are doing.
With that, this hearing is adjourned.
[Whereupon, at approximately 4:08 p.m., the Committee was adjourned.]
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A P P E N D I X
PREPARED STATEMENT OF DIANE M. ZUMATTO,

NATIONAL LEGISLATIVE DIRECTOR, AMVETS
Chairman Sanders, Ranking Member Burr, and distinguished Members of the
Committee: As an author of The Independent Budget (IB), I appreciate this opportunity to share with you the IBs recommendations in what we believe to be the
most fiscally responsible way of ensuring the quality and integrity of the care and
benefits earned by Americans veterans.
The venerable and honorable history of our national cemeteries spans roughly 150
years when the earliest military graveyards were, not surprisingly, situated at battle sites, near field or general hospitals and at former prisoner-of-war sites. With
the passage of the National Cemeteries Act of 1973 (PL 9343), the Department of
Veterans Affairs (VA) became responsible for the majority of our national cemeteries. The single most important obligation of the National Cemetery Administration (NCA) is to honor the memory of Americas brave men and women who have
selflessly served in this Nations Armed Forces. As of late 2010, there were more
than 20,021 acres of cemetery landscape, funerary monuments, grave markers, as
well as, other architectural features and memorial tributes, much of it historically
significant, included within established installations in the NCA which are therefore
representative of the very foundations of these United States.
The signing of the Veterans Programs Enhancement Act of 1998 (PL 105368) officially re-designated the National Cemetery System (NCS) to the now familiar National Cemetery Administration (NCA). The NCA currently maintains stewardship
of 133 of the Nations 147 national cemeteries, as well as 33 soldiers lots, including
two new national cemeteries scheduled to open in 2015. Since 1862 when President
Abraham Lincoln signed the first legislation establishing the national cemetery concept, more than 3.5 million burials have taken place in national cemeteries currently located in 39 states and Puerto Rico, with approximately 128,100 interments
expected in 2015.
There are an estimated 22.4 million veterans alive today and with the transition
of an additional 1 million servicemembers into veteran status over the next 12
months, this number is expected to continue to rise until approximately 2017. On
average, 14.4 percent of veterans choose a national or state veterans cemetery as
their final resting place. As new national and state cemeteries continue to open, and
as our aging veterans population continues to grow and we continue to be a nation
at war, the demand for burial at a veterans cemetery will continue to increase.
The Independent Budget veterans service organizations (IBVSOs) would like to acknowledge the devotion and commitment demonstrated by the NCA leadership, especially Undersecretary Steve Muro, and his staff in their continued dedication to
providing the highest quality of service to veterans and their families. It is in the
opinion of the IBVSOs that the NCA continues to meet its goals and the goals set
forth by others because of its true dedication and care for honoring the memories
of the men and women who have so selflessly served our Nation. We applaud the
NCA for recognizing that it must continue to be responsive to the preferences and
expectations of the veterans community by adapting or adopting new interment options and ensuring access to burial options in the national, state and tribal government-operated cemeteries. We also believe it is important to recognize the NCAs efforts in employing both disabled and homeless veterans.
NCA ACCOUNTS
While NCAs operating budget has remained fairly stagnant at around $250 million for 4 out of the last 5 years, their workload has been anything but static and
this trend is expected to continue for the foreseeable future. The IBVSOs are appreciative of the roughly $8 million increase in NCAs overall FY 2015 budget, however,
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that increase comes with a simultaneous $8.4 million reduction in the National
Shrine account.
Between FY 2014 and FY 2015, the number of gravesites needing maintenance
will increase by approximately 2.4%, while interments will increase by roughly
1.9%.
The NCA was also able to award 44 of its 48 minor construction projects and had
four unobligated projects that will be moved to FY 2012. Unfortunately, due to continuing resolutions and the current budget situation, the NCA was not able to
award the remaining four projects.
The IBVSOs support the operational standards and measures outlined in the National Shrine Commitment (PL 106117, Sec. 613) which was enacted in 1999 to ensure that our national cemeteries are the finest in the world. While the NCA has
worked diligently improving the appearance of our national cemeteries, they are still
a long way from where they should be.
The NCA has worked tirelessly to improve the appearance of our national cemeteries, investing an estimated $39 million into the National Shrine Initiative in FY
2011. According to NCA surveys, as of October 2011 the NCA has continued to make
progress in reaching its performance measures. Since 2006, the NCA has improved
headstone and marker height and alignment in national cemeteries from 67 percent
to 70 percent and has improved cleanliness of tombstones, markers and niches from
77 percent to 91 percent. Although the NCA is nearing its strategic goal of 90 percent and 95 percent, respectively, for height and alignment and cleanliness, more
funding is needed to continue this delicate and labor-intensive work. Therefore, the
IBVSOs recommend the NCAs Operations and Maintenance budget to be increased
by $20 million per year until the operational standards and measures goals are
reached.
The IBVSOs recommend a minimum Operational and Maintenance budget of
$260 million for the National Cemetery Administration for FY 2015, so it can meet
the demands for interment, gravesite maintenance and related essential elements
of cemetery operations. This request includes $34.5 million for the National Shrine
Initiative to ensure that our national cemeteries meet or exceed the highest standards of appearance required by their status as national shrines.
The national shrine funds would be used, among other things, to maintain:
occupied graves;
developed acreage;
historic structures; and
cemetery infrastructure
The IBVSOs call on the Administration and Congress to provide the resources
needed to meet the critical nature of the NCAs mission and to fulfill the Nations
commitment to all veterans who have served their country so honorably and faithfully.
STATE CEMETERY GRANT PROGRAMS
The State Cemetery Grants Program (SCGP) complements the National Cemetery
Administrations mission to establish gravesites for veterans in areas where it cannot fully respond to the burial needs of veterans. Several incentives are in place to
assist states in this effort. For example, the NCA can provide up to 100 percent of
the development cost for an approved cemetery project, including establishing a new
cemetery and expanding or improving an established state or tribal organization
veterans cemetery. New equipment, such as mowers and backhoes, can be provided
for new cemeteries. In addition, the Department of Veterans Affairs may also provide operating grants to help cemeteries achieve national shrine standards.
In FY 2011 the SCGP operated on an estimated budget of $46 million, funding
16 state cemeteries. These 16 state cemeteries included the establishment or ground
breaking of five new state cemeteries, three of which are located on tribal lands,
expansions and improvements at seven state cemeteries, and four projects aimed at
assisting state cemeteries to meet the NCA national shrine standards. Since 1978
the Department of Veterans Affairs has more than doubled the available acreage
and accommodated more than a 100 percent increase in burials through this
program.
With the enactment of the Veterans Benefits Improvement Act of 1998, the NCA
has been able to strengthen its partnership with states and increase burial services
to veterans, especially those living in less densely populated areas without access
to a nearby national cemetery. Through FY 2010, the state grant program has established 75 state veterans cemeteries in 40 states and U.S. territories. Furthermore, in FY 2011 VA awarded its first state cemetery grant to a tribal organization.
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The Independent Budget veterans service organizations recommend that Congress
fund the State Cemetery Grants Program at $48 million for FY 2015. The IBVSOs
believe that this small increase in funding will help the National Cemetery Administration meet the needs of the State Cemetery Grant Program, as its expected demand will continue to rise through 2017. Furthermore, this funding level will allow
the NCA to continue to expand in an effort of reaching its goal of serving 94 percent
of the Nations veteran population by 2015.
VETERANS BURIAL BENEFITS
Since the original parcel of land was set aside for the sacred committal of Civil
War Veterans by President Abraham Lincoln in 1862, more than 3 million burials
have occurred in national cemeteries under the National Cemetery Administration.
In 1973, the Department of Veterans Affairs established a burial allowance that
provided partial reimbursement for eligible funeral and burial costs. The current
payment is $2,000 for burial expenses for service-connected deaths, $300 for nonservice-connected deaths and a $700 plot allowance. At its inception, the payout covered 72 percent of the funeral costs for a service-connected death, 22 percent for a
non-service-connected death and 54 percent of the cost of a burial plot.
Burial allowance was first introduced in 1917 to prevent veterans from being buried in potters fields. In 1923 the allowance was modified. The benefit was determined by a means test until it was removed in 1936. In its early history the burial
allowance was paid to all veterans, regardless of their service connectivity of death.
In 1973, the allowance was modified to reflect the status of service connection.
The plot allowance was introduced in 1973 as an attempt to provide a plot benefit
for veterans who did not have reasonable access to a national cemetery. Although
neither the plot allowance nor the burial allowance was intended to cover the full
cost of a civilian burial in a private cemetery, the recent increase in the benefits
value indicates the intent to provide a meaningful benefit. The Independent Budget
veterans service organizations are pleased that the 111th Congress acted quickly
and passed an increase in the plot allowance for certain veterans from $300 to $700
effective October 1, 2011. However, we believe that there is still a serious deficit
between the original value of the benefit and its current value.
In order to bring the benefit back up to its original intended value, the payment
for service-connected burial allowance should be increased to $6,160, the non-service-connected burial allowance should be increased to $1,918 and the plot allowance
should be increased to $1,150. The IBVSOs believe Congress should divide the burial benefits into two categories: veterans within the accessibility model and veterans
outside the accessibility model.
Congress should increase the plot allowance from $700 to $1,150 for all eligible
veterans and expand the eligibility for the plot allowance for all veterans who would
be eligible for burial in a national cemetery, not just those who served during wartime. Congress should increase the service-connected burial benefits from $2,000 to
$6,160 for veterans outside the radius threshold and to $2,793 for veterans inside
the radius threshold.
Congress should increase the non-service-connected burial benefits from $300 to
$1,918 for all veterans outside the radius threshold and to $854 for all veterans inside the radius threshold. The Administration and Congress should provide the resources required to meet the critical nature of the National Cemetery Administrations mission and to fulfill the Nations commitment to all veterans who have
served their country so honorably and faithfully.
PREPARED STATEMENT OF PAUL R. VARELA, ASSISTANT NATIONAL LEGISLATIVE
DIRECTOR, DISABLED AMERICAN VETERANS (DAV)
Chairman Sanders, Ranking Member Burr, and Members of the Committee: On
behalf of the DAV and our 1.2 million members, all of whom are wartime disabled
veterans, I am pleased to present recommendations of The Independent Budget (IB)
for the fiscal year (FY) 2015 budget related to veterans benefits and the Veterans
Benefits Administration (VBA). The IB is jointly produced each year by DAV,
AMVETS, Paralyzed Veterans of America and Veterans of Foreign Wars of the
United States. This years IB contains numerous recommendations to improve veterans benefit programs and the claims processing system; however, in todays testimony I will highlight just some of the most critical ones for this Committee to
consider.
Mr. Chairman, the timely delivery of earned benefits to the millions of men and
women who have served in our Armed Forces is one of the most sacred obligations
of the Federal Government. The award of a service-connected disability rating does
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more than provide compensation payments; it is the gateway to an array of benefits
that support the recovery and transition of veterans, their families and survivors.
However, when these benefits are delayed or unjustly denied, the consequences to
veterans and their families can be devastating. For those wounded heroes who file
claims for disability compensation, the wait to receive an accurate rating decision
and award can take anywhere from a few months to several years; longer if they
have to appeal incorrect decisions.
In early 2010, Secretary Shinseki laid out an extremely ambitious goal for VBA
to achieve by 2015: process 100 percent of claims in less than 125 days, and do so
with 98 percent accuracy. Since that time, VBA has worked to completely transform
their IT systems, business processes and corporate culture, while simultaneously
continuing to process more than a million claims each year. VBA is actively rolling
out new organizational models and practices, and continuing to develop and deploy
new technologies almost daily.
Today there are about 685,000 claims for compensation and pension awaiting decisions at VBA. At the beginning of 2013, there were more than 860,000 pending
claims for disability compensation and pension. By the end of the year, that number
had dropped by more than 20 percent, down to about 685,000 pending. The number
of claims in the backloggreater than 125 days pendingdropped by about a third,
from more than 600,000 in January 2013 to just over 405,000 in January 2014. The
VBA increased the number of claims completed each month from an average of
about 89,000 during the first four months of the year to more than 114,000 during
the succeeding six months prior to the government shutdown. Claims production
dropped significantly following the shutdown and during the subsequent holiday
period.
In the midst of this massive transformation, it can be hard to get the proper perspective to measure whether their final systems will be successful, but we believe
there has been sufficient progress to merit continued support of the current transformation efforts. Now is not the time to stop or change direction.
We urge this Committee and Congress to provide the support and resources necessary to complete this transformation as currently planned, while continuing to exercise strong oversight to ensure that VBA remains focused on the long-term goal
of creating a new claims processing system that decides each claim right the first
time. In particular, the proposed FY 2015 budget for VBA includes additional funding for scanning and conversion of existing paper claims files, absolutely critical for
VBA to complete its transformation from an outdated, paper-based claims system
to a modern, paperless, automated claims system.
Mr. Chairman, one of the most important aspects needed to assure ongoing positive changes within the VBA is their willingness to remain open and partner with
veterans service organizations. Our organizations possess significant knowledge and
experience of the claims process and collectively we hold power of attorney (POA)
for millions of veterans who are filing or have filed claims. VBA recognized that
close collaboration with VSOs could not only reduce its workload, but also increase
the quality of its work. We make VBAs job easier by helping veterans prepare and
submit better claims, thereby requiring less time and resources for VBA to develop
and adjudicate them.
The IB veterans service organizations (IBVSOs) have been consulted about initiatives proposed or underway at VBA, including Fully Developed Claims (FDC), Disability Benefit Questionnaires (DBQs), the Veterans Benefit Management System
(VBMS), the Stakeholder Enterprise Portal (SEP), and the update of the Department of Veterans Affairs (VA) Schedule for Rating Disabilities (VASRD). Both Secretary Shinseki and Under Secretary Hickey have reached out to consult and collaborate with VSOs and we are confident that VBAs success going forward will require a continued and enhanced partnership that will result in better service and
outcomes for veterans.
Since 2009, VBA has made some significant changes in how claims are processed.
The most important amongst these is the development of the VBMS, its new IT system. VBMS has been rolled out to all 56 Regional Offices and VBA was able to complete implementation of the VBMS ahead of schedule in June; by the end of 2013,
nearly all of VBAs pending claims were processed using electronic files. It is important to remember that VBMS is not yet a finished product; rather, it continues to
be developed and perfected as it is deployed so it is still premature to judge whether
it will ultimately deliver all of the functionality and efficiency required to meet
VBAs future claims processing needs.
Another very important milestone was VBAs decision and commitment to scan
all paper claims files for every new or reopened claim requiring a rating-related action, and creating digital e-folders to serve as the cornerstone of the new VBMS system. E-folders facilitate instantaneous transmission and simultaneous reviewing of
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claims files. At present, there are an estimated 500,000 e-folders and that number
will continue to grow as the remaining ROs convert to VBMS this year.
In addition, the Appeals Management Center (AMC) is now working in VBMS and
able to review e-folders. The Board of Veterans Appeals (BVA) will also begin receiving appeals in VBMS on a pilot basis.
VBA also continues to strengthen its e-Benefits and SEP systems, which allow
veterans and their representatives to file claims, upload supporting evidence and
check on the status of pending claims. VBA has rolled out a new transformation organizational model (TOM) to every Regional Office that has reorganized workflow
by segmenting claims into different processing lanes depending upon the complexity
of the issues to be decided for each claim. Other key process improvements that we
strongly support include the FDC program, which expedites ready-to-rate claims,
and DBQs, which standardize and encourage the collection of private medical evidence to aid in rating decisions. To improve the accuracy of their work, VBA also
fulfilled one of our long-standing recommendations by creating local Quality Review
Teams (QRTs), whose primary function is to monitor claims processing in real time
to catch and correct errors before rating decisions are finalized.
CLAIMS PROCESSING RECOMMENDATIONS
Over the next year, Congress must continue to perform aggressive oversight of
VBAs ongoing claims transformation efforts, particularly new IT programs, while
actively supporting the completion and full implementation of these vital initiatives.
In order for VBAs current transformation plans to have any reasonable chance of
success, VBA must be allowed to complete and fully implement them. Congress
must continue to fully fund the completion of VBMS, including providing sufficient
funding for digital scanning and conversion of legacy paper files, as well as the development of new automation components for VBMS. At the same time, the IBVSOs
recommend that Congress encourage an independent, expert review of VBMS while
there is still time to make course corrections.
Congress must also encourage and support VBAs efforts to develop a new corporate culture based on quality, accuracy and accountability, as well as strengthen
the transmission and adoption of these values and appropriate supportive policies
throughout all VBA Regional Offices. The long-term success of all of VBAs transformation efforts will depend on the degree to which these changes are institutionalized and disseminated from the national level to the local level. In addition to
strengthening training, testing and quality control, VBA must be encouraged to
properly align measuring and reporting functions with desired goals and outcomes
for both its leadership and employees.
For example, as long as the most widely reported metric of VBAs success is the
Monday Morning Workload Reports, particularly the weekly update on the size of
the backlog, there will remain tremendous pressure throughout VBA to place production gains ahead of quality and accuracy. Similarly, if individual employee performance standards set unrealistic production goals, or fail to properly credit ancillary activity that contributes to quality but not production, those employees will be
incentivized to focus on activities that maximize only production. VBA must develop
more and better measures of work performance that focus on quality and accuracy,
both for the agency as a whole and for individual employees.
Furthermore, VBA must ensure that employee performance standards are based
on accurate measures of the time it takes to properly perform their jobs.
Congress must also ensure that VBA does not change its reporting or metrics for
the sole purpose of achieving statistical gains, commonly referred to as gaming the
system, in the absence of actual improvements to the system. For example, VBA
recently announced that they will change how errors are scored for multi-issue
claims.
Previously, a claim would be considered to have an error if one mistake on at
least one issue in the claim was detected during a STAR review. Under the new
error policy, if there are 10 issues in the claim and a single error is found on one
of the issues, that would now be scored as only 0.1 errors for that claim. While this
may be a more valid way of measuring technical accuracy, it also has the effect of
lowering the error rate without actually lowering the number of errors committed.
For instance, if VBA measures errors by issue, then the backlog of claims would not
be the reported 405,000, but a multiple of that based upon the total number of
issues, which would be in the millions. Likewise, VBAs allowance rate must be adjusted with this type of change in reporting to accurately reflect the number of
issues allowed out of the total number of issues claimed, which would be significantly lower than the current allowance rate per claim. In essence, VBA cannot simply change the metrics to suit their need to reflect gains or improvements; they
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must change all corresponding metrics such as claims versus issues, allowances
versus denials and remands, or similar.
Additionally, to make the system more efficient, Congress should enact and promote legislation and policies that maximize the use of private medical evidence to
conserve VBA resources and enable quicker, more accurate rating decisions for veterans. The IBVSOs have long encouraged VBA to make greater use of private medical evidence when making claims decisions, which would save veterans time and
VBA the cost of unnecessary examinations.
DBQs, many of which were developed in consultation with IBVSO experts, are designed to allow private physicians to submit medical evidence on behalf of veterans
they treat in a format that aids rating specialists. However, we continue to receive
credible reports from across the country that many Veterans Service Representatives (VSRs) and Rating Veterans Service Representatives (RVSRs) do not accept
the adequacy of DBQs submitted by private physicians, resulting in redundant VA
medical examinations being ordered and valid evidence supporting veterans claims
being rejected.
Although there are currently 81 approved DBQs, VBA has only released 71 of
them to the public for use by private physicians. In particular, VBA should allow
private treating physicians to complete DBQs for medical opinions about whether
injuries and disabilities are service-connected, as well as DBQs for PTSD, which
current VBA rules do not allow; only VA physicians can make PTSD diagnoses for
compensation claims. Congress should work with VBA to make both of these DBQs
available to private physicians.
To further encourage the use of private medical evidence, Congress should amend
title 38, United States Code, section 5103A(d)(1) to provide that, when a claimant
submits private medical evidence, including a private medical opinion, that is competent, credible, probative, and otherwise adequate for rating purposes, the Secretary shall not request a VA medical examination. This legislative change would
require VSRs and RVSRs to first document that private medical evidence was inadequate for rating purposes before ordering examinations, which are often
unnecessary.
VBA STAFFING AND RESOURCE RECOMMENDATIONS
Compensation Service Staffing

In recent years, VBA has seen a significant staffing increase because Congress
recognized that rising workload, particularly claims for disability compensation,
could not be addressed without additional personnel and thus provided additional
resources each year to do so. More than 5,000 full-time employee equivalents
(FTEE) were added to VBA over the past five years, a 33 percent increase, with
most of that increase going to the Compensation Service. In FY 2013, VBAs budget
supported an additional 450 FTEE above the FY 2012 authorized level, and the FY
2014 level added less than 100 new FTEE, and for FY 2015 the level of staffing remains unchanged.
Since the early part of 2013, the VBA has clearly made positive strides toward
increasing productivity, reducing the backlog of disability claims and, by the end of
2015, reaching the Secretarys goal of completing all claims in less than 125 days
with 98 percent accuracy. Over the past year, the total number of claims pending
dropped by about 20 percent, and the number in the backlog (over 125 days) decreased by more than a third. The VBA has employed a variety of aggressive initiatives, such as processing all claims pending longer than two years and then, when
completed, moving to process all claims pending longer than one year.
We believe allowing the VBA to again hire employees for a two-year temporary
term could supplement and/or alleviate the reliance on mandatory overtime and further reduce the backlog of disability claims to help reach the Secretarys goal by the
end of 2015. Such an initiative would also provide an outstanding opportunity for
VBA to have a generous pool of fully trained, qualified candidates to choose from
as replacements for full-time VBA employees who will undoubtedly be lost over the
next few years because of attrition.
However, rather than hiring new employees who need training and time to become fully productive, VBA would have instantly productive replacements ready and
would have the ability to hire only the best of these candidates. Therefore, we urge
Congress to provide the funding and resources necessary for VBA to hire a minimum of 1,000 new employees for a temporary two-year term.
Board of Veterans Appeals Staffing
Based on historical trends, the number of new appeals to the Board averages approximately five percent of all claims received, so as the number of claims processed
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by the VBA is expected to rise significantly, so too will the Boards workload rise
accordingly. Yet the budget provided to the Board has been declining, forcing it to
reduce the number of employees. Although the Board had been authorized to have
up to 544 FTEE in FY 2011, its appropriated budget could support only 532 FTEE
that year. In FY 2012, that number was further reduced to 510. At present, due
to cost-saving initiatives, the Board may be able to support as many as 518 FTEE
with the FY 2013 budget; however, this does not correct the downward trend over
the past several years, particularly as workload continues to rise.
The FY 2014 budget actually proposed cuts to funding for the Board and further
reduced staffing down to 492 FTEE, despite expected workload increases each year.
Projecting for FY 2014, the IBVSOs recommended a modest increase in staffing to
544 FTEE.
We are pleased Congress supported this recommendation and actually went beyond the suggested number by providing enough funding for BVA to increase staffing to approximately 640 FTEE to be in place by the end of FY 2014 and an FY
2015 budget request to increase the number of FTEE to 650.
VOCATIONAL REHABILITATION
Employment Service Staffing

In FY 2012, VAs Vocational Rehabilitation and Employment (VR&E) program,
also known as the VetSuccess program, had 121,000 participants in one or more of
the five assistance tracks of VR&Es VetSuccess program, an increase of 12.3 percent above the FY 2011 participation level of 107,925 veterans. In FY 2012, VR&E
had a total of 1,446 FTEE, and anticipates an increase of approximately 150 FTEE
for FY 2013. Given the estimated 10 percent workload increases for both FY 2013
and FY 2014, the IB estimated VR&E would need an additional 230 counselors in
FY 2014 in order to reduce their counselor-to-client ratio down to their stated goal
of 1:125.
An extension for the delivery of VR&E assistance at a key transition point for veterans is through the VetSuccess on Campus program. This program provides
support to student veterans in completing college or university degrees. VetSuccess
on Campus has developed into a program that places a full-time Vocational Rehabilitation Counselor and a part-time Vet Center Outreach Coordinator at an office
on campus specifically for the student veterans attending that college. These VA officers are there to help the transition from military to civilian and student life. The
VetSuccess on Campus program is designed to give needed support to all student
veterans, whether or not they are entitled to one of VAs education benefit
programs.
In FY 2015, Congress must provide the Vocational Rehabilitation and Employment Service with sufficient funding to support an adequate number of FTEE to
meet growing demand of the program and achieve its current caseload target of one
counselor for every 125 veteran clients and equitably allocate resources among
VAROs in a manner to achieve that target. This includes assuring that as other programs, such as the VetSuccess on Campus staffed with tenured VR&E counselors,
the workforce gaps left behind at the ROs are backfilled to keep pace with local
workload demands.
IT Enhancements
In addition, the VBMS was ultimately intended to include all of VBAs business
lines so that no matter where a veteran or survivor applied for benefits, the VBMS
would seamlessly connect them to all benefits they may be entitled to receive. While
some programs, such as Education Service, have developed adequate IT systems in
recent years, others, especially the Vocational Rehabilitation and Employment
(VR&E) service, are in dire need of a complete IT overhaul. VR&Es processing system, called the Corporate Winston-Salem, Indianapolis, Newark, Roanoke, Seattle
(CWINRS) system, is incapable of managing the many needs of this program. Rather than invest in short-term upgrades and patches, the IBVSOs believe that VBMS
development for VR&E should be accelerated.
VBA must complete the full development and integration of the VBMS to the
AMC, BVA, and Court of Appeals for Veterans Claims as well as to the other VBA
business lines and in particular VR&E.
The IBVSOs are pleased that the Administrations budget request for FY 2015 is
approximately $200 million more than the FY 2014 IT funding, and we support that
level of funding. More importantly, Congress must ensure that from the total IT
funding made available to VBA, that VR&E receives the necessary resources and
support to upgrade its antiquated IT systems.
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RECOMMENDATIONS FOR IMPROVEMENTS TO VA BENEFITS
Annual Cost-of-Living Adjustment (COLA)

Congress has annually authorized increases in compensation and dependency and
indemnity compensation (DIC) by the same percent as Social Security is increased.
Under current law, the government monitors inflation throughout the year and,
if inflation occurs, automatically increases Social Security payments by the percent
of increase for the following year, which the Congress then applies to veterans
programs.
While Congress has always increased compensation and DIC based on inflation,
there have been years when such increases were delayed, which puts unnecessary
financial strain on veterans and their survivors.
The IBVSOs urge Congress to enact legislation indexing compensation and DIC
to Social Security COLA increases.
End Rounding Down of Veterans and Survivors Benefits Payments
In 1990, Congress, in an omnibus reconciliation act, mandated that veterans and
survivors benefit payments be rounded down to the next lower whole dollar. While
this policy was initially limited to a few years, Congress has continued that policy.
The cumulative effect of this provision of the law effectively levies a tax on totally
disabled veterans and their survivors. Congress should repeal the current policy of
rounding down veterans and survivors benefits payments.
On November 21, 2013, with the Presidents signature, the Veterans Compensation Cost-of-Living Adjustment Act became Public Law 11352. The Act provided a
1.5% increase in veterans disability compensation, DIC and other related veterans
benefits, effective December 1, 2013. Unlike COLAs in the past, this COLA did not
include the provision of rounding down increases to the nearest whole dollar
amount.
The IBVSOs urge Congress not to return to a policy of rounding down veterans
and survivors benefits payments.
Reject Any Proposal to Use the Chained CPI
In the past year, there has been much discussion about replacing the current CPI
formula used for calculating the annual Social Security COLA with the Bureau of
Labor Statistics (BLS) new formula commonly termed the chained CPI. Such a
change would be expected to significantly reduce the rates paid to Social Security
recipients, and thereby help to lower the Federal deficit. Since the Social Security
COLA is also applied annually to the rates for VA disability compensation, DIC, and
pensions for wartime veterans and survivors with limited incomes, its application
would mean systematic reductions for millions of veterans, their dependents and
survivors who rely on VA benefit payments. The IBVSOs urge Congress to reject
any and all proposals to use the chained CPI for determining Social Security
COLA increases, which would have the effect of significantly reducing the level of
vital benefits provided to millions of veterans and their survivors.
The IBVSOs also note that the CPI index used for Social Security does not include
increases in the cost of food or gasoline, both of which have risen significantly in
recent years. While no inflation index is perfect, the IBVSOs believe that VA should
examine whether there are other inflation indices that would more appropriately
correlate with the increased cost of living experienced by disabled veterans and their
survivors.
End Prohibition against Concurrent Receipt of VA Disability Compensation and
Military Longevity Retired Pay
Many veterans retired from the Armed Forces based on longevity of service must
forfeit a portion of their retired pay, earned through faithful performance of military
service, before they receive VA compensation for service-connected disabilities. This
is inequitablemilitary retired pay is earned by virtue of a veterans career of service on behalf of the Nation, careers of usually more than 20 years. Entitlement to
compensation, on the other hand, is paid solely because of disability resulting from
military service, regardless of the length of service. Most nondisabled military retirees pursue second careers after serving in order to supplement their income, thereby
justly enjoying a full reward for completion of a military career with the added reward of full civilian employment income. In contrast, military retirees with serviceconnected disabilities do not enjoy the same full earning potential since their earning potential is reduced commensurate with the degree of service-connected
disability.
In order to place all disabled longevity military retirees on equal footing with nondisabled military retirees, there should be no offset between full military retired pay
and VA disability compensation. To the extent that military retired pay and VA dis-
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ability compensation offset each other, the disabled military retiree is treated less
fairly than is a nondisabled military retiree by not accounting for the loss in earning
capacity. Moreover, a disabled veteran who does not retire from military service but
elects instead to pursue a civilian career after completing a service obligation can
receive full VA disability compensation and full civilian retired payincluding retirement from any Federal civil service position.
While Congress has made progress in recent years in correcting this injustice, current law still provides that service-connected veterans rated less than 50 percent
disabled who retire from the Armed Forces on length of service may not receive disability compensation from VA in addition to full military retired pay. The IBVSOs
believe the time has come to remove this prohibition completely. Congress should
enact legislation to repeal the inequitable requirement that veterans military longevity retired pay be offset by an amount equal to the disability compensation
awarded to disabled veterans rated less than 50 percent, the same as exists for
those rated 50 percent or greater.
SURVIVOR BENEFITS
Increase DIC for Surviving Spouses of Servicemembers

The current rate of compensation paid to the survivors of certain deceased veterans rated permanently and totally disabled and deceased servicemembers is inadequate and inequitable. Under current law, the surviving spouse of a veteran who
had a total disability rating is entitled to the basic rate of DIC. A supplemental payment is provided to those spouses who were married for at least eight years during
which time the veteran was rated permanently and totally disabled.
However, surviving spouses of veterans or military servicemembers who die before
the eight-year eligibility period, or who die on active duty, respectively, only receive
the basic rate of DIC.
Insofar as DIC payments are intended to provide surviving spouses with the
means to maintain some semblance of financial stability after losing their loved
ones, the rate of payment for service-related deaths of any kind should not vastly
differ. Surviving spouses, regardless of the status of their sponsors at the time of
death, face the same financial hardships once deceased sponsors incomes no longer
exist. Congress should authorize DIC eligibility at increased rates to survivors of
servicemembers who died either before the eight-year eligibility period passes or
while on active duty at the same rate paid to the eligible survivors of totally disabled service-connected veterans who die after the eight-year eligibility period.
Repeal of the DIC-SBP Offset
The current requirement that the amount of an annuity under the Survivor Benefit Plan (SBP) be reduced on account of, and by an amount equal to, DIC is inequitable. A veteran disabled in military service is compensated for the effects of service-connected disability. When a veteran dies of service-connected causes, or following a substantial period of total disability from service-connected causes, eligible
survivors or dependents receive DIC from the VA. This benefit indemnifies survivors, in part, for the losses associated with the veterans death from service-connected causes or after a period of time when the veteran was unable, because of
total disability, to accumulate an estate for inheritance by survivors.
Career members of the Armed Forces earn entitlement to retired pay after 20 or
more years of service. Survivors of military retirees have no entitlement to any portion of the veterans military retirement pay after his or her death, unlike many retirement plans in the private sector. Under the SBP, deductions are made from the
veterans military retirement pay to purchase a survivors annuity. This is not a gratuitous benefit, but is purchased by a retiree.
Upon the veterans death, the annuity is paid monthly to eligible beneficiaries
under the plan. If the veteran died from other than service-connected causes or was
not totally disabled by service-connected disability for the required time preceding
death, beneficiaries receive full SBP payments. However, if the veterans death was
a result of military service or after the requisite period of total service-connected
disability, the SBP annuity is reduced by an amount equal to the DIC payment.
When the monthly DIC rate is equal to or greater than the monthly SBP annuity,
beneficiaries lose the SBP annuity in its entirety.
The IBVSOs believe this offset is inequitable because no duplication of benefits
is involved. Payments under the SBP and DIC programs are made for different purposes. Under the SBP, coverage is purchased by a veteran and at the time of death,
paid to his or her surviving beneficiary. On the other hand, DIC is a special indemnity compensation paid to the survivor of a servicemember who dies while serving
in the military, or a veteran who dies from service-connected disabilities. In such
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cases, DIC should be added to the SBP, not substituted for it. Surviving spouses
of Federal civilian retirees who are veterans are eligible for DIC without losing any
of their purchased Federal civilian survivor benefits.
The offset penalizes survivors of military retirees whose deaths are under circumstances warranting indemnification from the government separate from the annuity funded by premiums paid by the veteran from his or her retired pay.
Congress should repeal the inequitable offset between DIC and the SBP because
there is no duplication between these two distinct benefits.
Retention of Remarried Survivors Benefits at Age 55
Congress should lower the age required for remarriage for survivors of veterans
who have died on active duty or from service-connected disabilities to be eligible for
retention of DIC to conform with the requirements of other Federal programs.
Current law allows retention of DIC on remarriage at age 57 or older for eligible
survivors of veterans who die on active duty or of a service-connected injury or illness. Although the IBVSOs appreciate the action Congress took to allow restoration
of this rightful benefit, the current age threshold of 57 years is arbitrary.
Remarried survivors of retirees of the Civil Service Retirement System, for example, obtain a similar benefit at age 55. This would also bring DIC in line with SBP
rules that allow retention with remarriage at the age of 55. Equity with beneficiaries of other Federal programs should govern Congressional action for this deserving group. Congress should enact legislation to enable survivors to retain DIC
on remarriage at age 55 for all eligible surviving spouses.
Mr. Chairman, that concludes my statement and I would be happy to answer any
questions you or other Members of the Committee may have.
PREPARED STATEMENT
OF
PARALYZED VETERANS
OF
AMERICA
Chairman Sanders, Ranking Member Burr, and Members of the Committee, as

one of the four co-authors of The Independent Budget (IB), Paralyzed Veterans of
America (PVA) is pleased to present the views of The Independent Budget regarding
the funding requirements for the Department of Veterans Affairs (VA) for FY 2015.
As Congress and the Administration continue to face immense pressure to reduce
Federal spending, we cannot emphasize enough the importance of ensuring that sufficient, timely and predictable funding is provided to the Department of Veterans
Affairs (VA). The co-authors of The Independent BudgetAMVETS, Disabled American Veterans, Paralyzed Veterans of America, and Veterans of Foreign Warsrecognize the pressure that the Administration and Congress face; however, we believe
that the ever-growing demand for health care services certainly validates the continued need for sufficient funding. We also understand that the VA has fared better
than most Federal agencies with regards to budget proposals and appropriations.
However, we are concerned that discretionary funding for the VA is no longer keeping pace with medical care inflation or health care demand.
That being said, we certainly appreciate the increases offered by the Administrations budget for FY 2015 and the FY 2016 advance appropriations, particularly
with regards to health care and benefits services. Unfortunately, we have real concerns that the serious lack of commitment to infrastructure funding to support the
system will undermine the VAs ability to deliver those services. Similarly, we remain concerned that the funding levels provided by the House and Senate Committees on Appropriations in the recently passed omnibus appropriations bill will be insufficient to address the continuously growing demand for VA health care services.
Moreover, The Independent Budget co-authors oppose the steps VA has taken in
recent years in order to generate resources to meet ever-growing demand on the VA
health-care system. The Administration continues to rely upon management improvements, a popular gimmick that was used by previous Administrations to generate savings and offset the growing costs to deliver care. Unfortunately, these savings are often never realized leaving VA short of necessary funding to address evergrowing demand on the health-care system.
Of even greater concern is the fact that the VA continues to overproject and
underperform with its medical care collections estimates. Overestimating collections
estimates affords Congress the opportunity to appropriate fewer discretionary dollars for the health care system. However, when the VA fails to achieve those collections estimates, it is left with insufficient funding to meet the projected demand.
As long as this scenario continues, the VA will find itself falling farther and farther
behind in its ability to care for those men and women who have served and sacrificed for this Nation. In fact, we believe that is exactly what is happening now.
For example, the VA originally projected collections of approximately $3.3 billion in
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FY 2013 and FY 2014 and approximately $3.2 billion in FY 2015. Congress based
its appropriations for the VA for those fiscal years on those projected collections.
However, the VA subsequently revised its estimates anticipating collections of $2.8
billion in both FY 2013, $2.9 billion in FY 2014, and less than $3.1 billion for FY
2015. The flawed projections estimates and the dollars appropriated by Congress in
each of those fiscal years suggest that the VA may have received $1.0 billion too
little in resources during that period. And yet, this shortfall has never been addressed through supplemental appropriations.
Too often in meetings with congressional offices, staff members have proclaimed
the belief that VA has received too much money. We would ask the Committee how
that logic passes when we have clearly identified a shortfall simply based on faulty
collections estimates. Similarly, we would ask that the Committee proceed with caution in FY 2016 as the VA has once again projected a collections estimate of $3.3
billion despite the fact that its recent performance suggests that it will not achieve
that level. The fact that the VA continues to experience problems with its medical
care collections reflects an even greater need for Congress to properly analyze, and
if necessary, revise the advance appropriations from previous years to ensure that
the VA health care system is getting the resources it actually needs.
FUNDING FOR FY 2015
For FY 2015, The Independent Budget recommends approximately $61.1 billion for
total medical care, an increase of approximately $3.4 billion over the FY 2014 operating budget. Meanwhile, the Administration recommended in its FY 2015 Budget
Request a revised advance appropriation estimate for FY 2015 of approximately
$56.0 billion in discretionary funding for VA medical care. This revised estimate reflected a projected increase in discretionary funding of approximately $368 million
over the recently approved advance appropriations level. When combined with the
approximately $3.1 billion revised projection for medical care collections (decreased
from $3.2 billion in last years estimate), the total available operating budget recommended for FY 2015 is approximately $59.1 billion. This reflects an increase of
$1.7 billion over the previously approved FY 2014 operating budget, an amount that
we believe is inadequate to fully meet health care demand.
The medical care appropriation includes three separate accountsMedical Services, Medical Support and Compliance, and Medical Facilitiesthat comprise the
total VA health-care funding level. For FY 2015, The Independent Budget recommends approximately $49.3 billion for Medical Services. Our Medical Services
recommendation includes the following recommendations:
Current Services Estimate .................................................................... $47,616,189,000
Increase in Patient Workload ...............................................................
1,171,260,000
Additional Medical Care Program Costs .............................................
500,000,000
Total FY 2014 Medical Services .................................................... $49,287,449,000
Our growth in patient workload is based on a projected increase of approximately
87,000 new unique patientspriority groups 18 veterans and covered nonveterans.
We estimate the cost of these new unique patients to be approximately $853 million.
The increase in patient workload also includes a projected increase of 83,350 new
Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF), as well as
Operation New Dawn (OND) veterans at a cost of approximately $318 million. The
increase in utilization among OEF/OIF/OND veterans is supported by the average
annual increase in new users from FY 2002 through the 3rd quarter of FY 2013.
The Independent Budget also believes that there are additional projected funding
needs for VA. Specifically, we believe there is real funding needed to address the
array of long-term care issues facing the VA, including the shortfall in institutional
capacity, and to provide additional centralized prosthetics funding (based on actual
expenditures and projections from the VAs prosthetics service). The Independent
Budget recommends $375 million directed toward VA long-term care programs. In
order to support the rebalancing of VA long-term care in FY 2015, $125 million
should be provided. Additionally, $95 million should be targeted at the VAs Veteran
Directed-Home and Community Based Services (VD-HCBS) program. The remainder
of the $375 million ($155 million) should be dedicated to increasing the VAs longterm care average daily census (ADC) to the level mandated by Public Law 106
117, the Veterans Millennium Health Care and Benefits Act. In order to meet the
increase in demand for prosthetics, the IB recommends an additional $125 million.
This increase in prosthetics funding reflects an increase in expenditures from FY
2013 to FY 2014 and the expected continued growth in expenditures for FY 2015.
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For Medical Support and Compliance, The Independent Budget recommends approximately $6.1 billion. Finally, for Medical Facilities, The Independent Budget recommends approximately $5.7 billion. Our Medical Facilities recommendation includes the addition of $650 million to the baseline for Non-Recurring Maintenance
(NRM). The Administrations request over the last two cycles represents a wholly
inadequate request for NRM funding, particularly in light of the actual expenditures
that are outlined in the budget justification. In fact, the VAs FY 2015 and FY 2016
advance appropriations request for infrastructure is wholly insufficient (a topic that
will be addressed by the VFW in its statement to the Committee), particularly with
regards to Major and Minor Construction and Non-Recurring Maintenance (NRM).
The VA continues to slash funding for NRM as evidenced by the rapidly decreasing
estimates for Medical Facilities. And yet, the VA admits in its own documents that
it spends between $1.3 billion and $1.4 billion per year on NRM. Similarly, we are
extremely disappointed that the VA has requested such a laughable funding level
for Major and Minor Construction, particularly considering the rapidly advancing
age and condition of its infrastructure. It is time for Congress to take the necessary
steps to reverse this course before the VA system collapses on itself.
The Independent Budget co-authors have ongoing concerns about the lack of investment in Medical and Prosthetic Research. While we recognize that the Administration requested an increase in the research account for FY 2015, the $3 million
increase does not even keep pace with inflation. If the VA is to remain a world leader in research, it is imperative that the Administration get serious about requesting
real dollars and that Congress provide adequate resources to continue those efforts.
With this point in mind, The Independent Budget recommends $611 million for Medical and Prosthetic Research funding for FY 2015. Similarly, we recommend at least
$50 million in Major Construction and $175 million in Minor Construction and NRM
to address the deteriorating state of VA research infrastructure. Failure to make
these investments will undermine the VAs ability to continue to attract the best
medical professionals into the research field and promote cutting edge advancements to benefit the men and women who have made great physical and mental sacrifices in defense of this Nation.
ADVANCE APPROPRIATIONS FOR FY 2016
Just as we did for the first time last year, The Independent Budget once again
offers baseline projections for funding through advance appropriations for the medical care accounts for FY 2016. While we have previously deferred to the Administration and Congress to provide sufficient funding through the advance appropriations process, we have growing concerns that this responsibility is not being taken
seriously.
total medical care. The Administrations Budget Request includes approximately
$62.0 billion for total medical care$58.7 billion in discretionary spending and approximately $3.3 billion in medical care collections. We appreciate the fact that the
Administration has offered a substantial increase in health care funding from FY
2015 to FY 2016 (as a part of its advance appropriations request).
Medical Services. Our Medical Services recommendation includes the following recommendations:
Current Services Estimate .................................................................... $49,193,067,000
Increase in Patient Workload ...............................................................
1,074,225,000
Additional Medical Care Program Costs .............................................
510,000,000
Total FY 2015 Medical Services .................................................... $50,777,292,000
Our growth in patient workload is based on a projected increase of approximately
67,000 new unique patientspriority groups 18 veterans and covered nonveterans. We estimate the cost of these new unique patients to be approximately
$746 million. The increase in patient workload also includes a projected increase of
83,350 new Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF),
as well as Operation New Dawn (OND) veterans at a cost of approximately $328
million.
Last, The Independent Budget believes that there are additional projected funding
needs for VA. For FY 2016, we believe that an additional $375 million should be
invested to address the spectrum of long-term care issues within the VA. Additionally, we believe that a continued increase in centralized prosthetics funding will be
essential. In order to meet the continued increase in demand for prosthetics, the IB
recommends an additional $135 million.
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For Medical Support and Compliance, The Independent Budget recommends approximately $6.0 billion. Finally, for Medical Facilities, The Independent Budget recommends approximately $5.7 billion. Our Medical Facilities recommendation includes the addition of $900 million to the baseline for Non-Recurring Maintenance
(NRM). Last year, the Administrations recommendation for NRM reflected a projection that would place the long-term viability of the health care system in serious
jeopardy.
ADVANCE APPROPRIATIONS FOR ALL VA ACCOUNTS
The Independent Budget co-authors are concerned that the broken appropriations
process continues to have a negative impact on the operations of the VA. Once again
this year Congress failed to fully complete the appropriations process in the regular
order. In fact, many Federal operations were shuttered as part of a partial government shutdown in October 2013. This had a significant negative impact on many
of the services provided by the VA. While VA health care was shielded from this
political disaster, benefits services, research activities, and general operations for
the rest of the VA were impacted. Additionally, many of the operations that support
the health care system, particularly through the Information Technology system,
were negatively impacted complicating the VAs ability to delivery timely, quality
health care.
We also have real concerns about the advance appropriations process as it currently functions. Our intent for this process was for the Administration to request
an advance appropriation for a given fiscal year (two years ahead of the start of that
fiscal year), and then revise that recommendation in its next budget request immediately prior to the start of the fiscal year in question. We appreciate the fact that
the Administrations FY 2015 Budget Request does include a significant revision for
Medical Services reflecting an increased need for funding of approximately $368 million. However, during past budget cycles, the Administration has offered very little
revision in its advance appropriations requests essentially asking for the same funding level. Moreover, we believe that Congress has not done its due diligence to adequately analyze the advance appropriations recommendations and make any necessary changes through supplemental appropriations. In fact, once Congress has approved an advance appropriations level for VA, it has not revised its previous years
decision in any appreciable way. This undermines the principle benefit of advance
appropriationshaving additional time to ensure that sufficient funds are provided.
With this in mind, we call on Congress to immediately approve legislation that
would extend advance appropriations to all VA discretionary and mandatory appropriations accounts. Advance appropriations have shielded VA health care from most
of the harmful effects of the partisan bickering and political gridlock that has paralyzed Washington in recent years. Now Congress must provide the same protections
to all remaining discretionary programs, including Medical and Prosthetic Research,
General Operating Expenditures, Information Technology, the National Cemetery
Administration, Inspector General, Major Construction, Minor Construction, State
Home Construction Grants, State Cemetery Grants and other discretionary accounts, and all mandatory funded programs, including disability compensation, pension, education benefits, and dependency and indemnity compensation.
Chairman Sanders, the co-authors of The Independent Budget sincerely appreciate
your commitment to this effort. Similarly, we applaud Senator Boozman and Senator Begich for leading this effort in the Senate by introducing S. 932, the Putting
Veterans Funding First Act. We commit to you our steadfast support to see this
legislation through to final passage and enactment. Enactment of S. 932 will generally free all VA services from the political gridlock that has crippled the appropriations process in Congress.
In the end, it is easy to forget that the people who are ultimately affected by
wrangling over the budget are the men and women who have served and sacrificed
so much for this Nation. We hope that you will consider these men and women
when you develop your budget views and estimates, and we ask that you join us
in adopting the recommendations of The Independent Budget.
This concludes our statement. We would be happy to answer any questions you
may have.
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Senate Hearing, 113TH Congress - The Fiscal Year 2015 Budget For Veterans' Programs

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Senate Hearing, 113TH Congress - The Fiscal Year 2015 Budget For Veterans' Programs

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S. HRG.

THE FISCAL YEAR 2015 BUDGET FOR

COMMITTEE ON VETERANS AFFAIRS

MARCH 12, 2014

Printed for the use of the Committee on Veterans Affairs

U.S. GOVERNMENT PUBLISHING OFFICE

For sale by the Superintendent of Documents, U.S. Government Publishing Office

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COMMITTEE ON VETERANS AFFAIRS

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Sanders, Hon. Bernard, Chairman, U.S. Senator from Vermont ........................

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THE FISCAL YEAR 2015 BUDGET FOR

OPENING STATEMENT OF HON. BERNARD SANDERS,

Chairman SANDERS. OK, lets get to work.

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Senator ISAKSON. Well, thank you, Mr. Chairman.

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Senator BROWN. Thank you, Mr. Chairman. I appreciate your

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Senator JOHANNS. Mr. Chairman, thank you.

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Senator TESTER. Thank you, Mr. Chairman.

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Senator HIRONO. Thank you, Mr. Chairman.

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Secretary SHINSEKI. Chairman Sanders, Senator Isakson, and

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At VA, we are committed to responsible stewardship, using resources effectively

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